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 Psychology
for
Nurses

Second Edition

R Sreevani MSc (N)

Professor and HOD
Department of Mental Health Nursing
Sri Devaraj Urs College of Nursing
Kolar, Karnataka, India

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Psychology for Nurses

First Edition: 2009

Second Edition: 2013

ISBN: 978-93-5090-294-3
 Foreword to the First Edition

It is a matter of immense pleasure that Ms R Sreevani, MSc (N) has again put her efforts together for the
student community by compiling a comprehensive textbook titled Psychology for Nurses and requested me
to give foreword for the same. Her previous publication A Guide to Mental Health and Psychiatric Nursing
has been a phenomenal success and gained much recognition with the student community in particular.
The present publication broadly covers fundamental psychological concepts for the undergraduate and
graduate nurses with special focus on nursing implications making it unique. The text is presented in line with
the recently introduced Indian Nursing Council (INC) syllabus for GNM, BSc (N) and PC BSc (N) students.
The language used is simple and understandable. Right mix of tables, flow charts and figures has been
used to make the concept comprehensible and aid learning. Units on Sensation and Perception, Learning,
Memory, Thinking, Intelligence, Motivation, Emotions, Attitudes, Personality, Developmental Psychology,
Social Psychology, Guidance and Counseling and Psychological Assessment have been dealt with in depth
and incorporated Nursing Implications making it a must-buy for the nursing personnel.
I wish her success in all her future endeavors.

K Reddemma
Professor and HOD
Department of Nursing
National Institute of Mental Health and Neurosciences (NIMHANS)
Bengaluru, Karnataka, India
 Preface to the Second Edition

The first edition of Psychology for Nurses received strong acclaim for its content, approach and organization.
While retaining these strengths in the second edition, I have added many more illustrations, figures, flow
charts and tables where required. All theoretical aspects and psychological principles are well presented with
figures and flow charts. They are immediately followed up with application in nursing practice enabling the
students to grasp the concept.
Complex topics are also presented very interestingly. After going through this textbook, the students will
be able to manage their examinations on psychology and also meet the psychological needs of patients more
effectively.
The second edition is dramatically different from the first edition as it has been aligned as per the revised
Indian Nursing Council (INC) syllabus. In the said process, the textbook has been rewritten and reorganized
into nine chapters. Some of the noteworthy changes and highlights are as under:

Text Organization
Chapter 1–Deals with the history, origin and scope of psychology and also focuses on methods of psychology.
Chapter 2–Features the mind-body relationship, influence of heredity and environment on behavior, role of
nervous system in behavior. The chapter ends with integrated responses of an organism.
Chapter 3–Incorporates a very detailed description of cognitive processes like attention, perception, learning,
memory, thinking, intelligence and aptitude.
Chapter 4–Covers topics on motivation and emotional processes with a special focus on the related theories.
It also includes a detailed description of the stress cycle, sources of stress and adaptation to stress.
The chapter ends with a topic on behavior and attitude.
Chapter 5–Gives a classic account on theories of personality development and ends with alteration and
factors influencing personality.
Chapter 6–Has been devoted to developmental psychology and psychology of vulnerable individuals.
Chapter 7–Deals with mental hygiene and mental health and also focuses on preventive mental health
strategies, mental health services available in our country. The chapter ends with a detailed
account on guidance and counseling.
Chapter 8–Deals with psychological assessment and tests and role of the nurses.
Chapter 9–Focuses on types, causes and nursing implications of individual differences.
Each chapter is followed by certain important questions culled out from the previous examinations. This
will allow the students to get an idea of what is expected out of them. Chapter-wise multiple choice questions
(MCQs) have been included at the end of the textbook so as to inculcate an active learning exercise. This
book also includes an exhaustive glossary of various terms used in psychology which is a must for gaining
a broad understanding of the subject. A list of bibliography has been furnished at the end of the textbook for
further reading.
Students of general nursing, MSc nursing and other health professionals interested in getting an overview
of psychology may also find it useful.
All constructive suggestions from the readers in making this book more valuable and helpful will be
earnestly solicited. I am confident that the new edition reflects what instructors want and need: a book that
motivates students to understand and apply psychology to their own lives.

R Sreevani
 Preface to the First Edition

As per the Indian Nursing Council (INC) syllabus for GNM, BSc (N), PC BSc (N) students, psychology
is prescribed as a subject in their academic curriculum. During my teaching experience, I have always
found that, though many books have been published on the subject, they do not really cater to the specific
needs of the student community, nurses in particular. The students have often sought recommendations for
a publication which caters to their complete syllabus. For lack of such a textbook, there was always a high
demand for prepared notes which they could use during their examinations. This edition is a genuine effort to
mitigate their hardship and also to stimulate academic interest and build an appreciation of the relevance of
psychology, motivating and engaging the students.
This edition of Psychology for Nurses though will add to the Psychology section in the book shelves,
it will definitely be a special one for the nurse community. In this edition a concerted effort has been made
to cover the basic principles of psychology and also focus on applied topics in units such as Sensation
and Perception, Learning, Memory, Thinking, Intelligence, Motivation, Emotions, Attitudes, Personality,
Developmental Psychology, Social Psychology, Guidance and Counseling and Psychological Assessment.
The matter has been produced in a simple language with tables, figures and flow charts so as to directly
support learning, easy understanding and retention of the concept. Learning new concepts and theories is
of no much value unless the same can be put to use in real-life situations. In a unique effort to bridge the
gap between theory and practice, special care has been exercised to incorporate Nursing Implications at all
appropriate places, providing ample opportunity for the intelligent nurse to conceptualize her role.
An exhaustive glossary has been provided at the end of the text to aid the student nurse understand the
meaning of the keywords and their usage. To facilitate the students from the examination point of view, a set
of review questions—long essays, short essays and short answers type have been included at the end of each
unit. To assess the level of understanding gained on various topics, a unit-wise question bank (objective) has
been provided at the end of the text.
I will be deriving immense satisfaction, if the nursing personnel apply the psychological principles
described in this textbook in their day-to-day learning and practice. I am confident that, this book will provide
good teaching material for the instructor and moreover motivate the students towards understanding and
applying psychology in their job and personal lives as well. Suggestions for improvement will be gratefully
acknowledged.

R Sreevani
 Acknowledgments

Deep felt gratitude to:

• My family which made it all happen. Especially my husband, A Giridhar, who expressed his encouragement
and enthusiasm in the project by patiently typing the manuscript and reading through each of the proofs
carefully and suggesting valuable additions. My children, Pranith and Daivik, who are the focal point of
my life.
• Dr K Reddemma, Professor and HOD, Department of Nursing, National Institute of Mental Health and
Neurosciences (NIMHANS), Bengaluru, Karnataka, India, for her suggestions and guidance, and for
accepting to give the foreword to the first edition.
• Ms Prasanthi N, my dear friend, for the abundant support and guidance provided throughout the venture.
Her love and encouragement have enthused me and injected the much-needed confidence required in
accomplishing the task.
• All my colleagues, in particular, Mrs Jairakiniaruna, for her valuable suggestions.
• All the authors, whose books I have referred in the compilation of this text.
• A word of appreciation for Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and
Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi,
India, for making it possible and putting it on the shelf, and also Mr Venugopal (Manager, Bengaluru
Branch), for the unstinting moral and material support.
 Contents

1. Introduction to Psychology 1
Meaning of Behavior 1
History and Origin of Science of Psychology 1
Definitions of Psychology 3
Scope of Psychology 4
Relevance to Nursing 7
Methods of Psychology 9

2. Biology of Behavior 14
Body-Mind Relationship—Modulation Process in Health and Illness 14
Genetics and Behavior: Heredity and Environment 15
Brain and Behavior: Nervous System, Neurons and Synapse 18
Nervous System 23

3. Cognitive Processes 30
Attention 30
Alterations in Attention (Distraction) 33
Perception 33
Learning 37
Laws of Learning 41
Theories of Learning 42
Transfer of Learning 52
Memory 55
Thinking 65
Intelligence 73
Aptitude 76
Alterations in Cognitive Processes 83
Applications of Nursing Profession 86

4. Motivation and Emotional Processes 92

Needs 92
Drives 93
Incentives 93
Motives 94
Concepts of Motivation 94
Types of Motives 94
Theories of Motivation 96
Motives and Behavior 100
Frustration 100
Conflict 102
Resolution of Frustration and Conflict 103
xiv Psychology for Nurses

Emotions and Stress 103

Components of Emotion 103
Changes in Emotional Reactions 105
Theories of Emotion 105
Emotional Adjustments 108
Emotions in Health and Illness 108
Stress 109
Stressors 109
Stress Cycle 110
Effects of Stress 111
Adaptation to Stress 111
Coping with Stress 114
Attitude 116
Characteristics/Nature of Attitude 116
Formation and Development of Attitude 117
Behavior and Attitude 118
Attitudinal Change 119
Factors Affecting Attitudinal Change 119
Psychometric Assessment of Motivation, Emotions and Attitudes 119
Alterations in Emotions during Illness 120
Nursing Implications of Motives 122
Nursing Implications of Emotions 122
Attitude during Health and Illness 123
Nursing Implications of Attitude 123

5. Personality 126
Topography of Personality 126
Types of Personality 126
Theories of Personality Development 128
Psychoanalytic Theory 130
Theory of Psychosocial Development 133
Humanistic Approach 135
Trait and Type Theories of Personality 136
Learning Theories of Personality 137
Psychometric Assessment of Personality 138
Alterations in Personality due to Illness 141
Alterations in Personality due to Personality Disorders 142
Applications 144

6. Developmental Psychology 146

Psychology of People at Different Ages from Infancy to Old Age 146
Psychology of Vulnerable Individuals 152

7. Mental Hygiene and Mental Health 158

Mental Hygiene 158
Mental Health 158
Concepts of Mental Hygiene 158
 Contents xv
Concepts of Mental Health—Jahoda (1958) 159
Characteristics of a Mentally Healthy Person 159
Warning Signs of Poor Mental Health 160
Promotive and Preventive Mental Health Strategies 160
Mental Health Services 163
Ego Defence Mechanisms and Implications 164
Personal and Social Adjustment 167
Guidance and Counseling 168
Counseling 170

8. Psychological Assessment and Tests 176

Types of Psychological Tests 176
Classification of Psychological Tests 176
Development of Psychological Tests 177
Characteristics of Psychological Tests 177
Principles of Psychological Tests 178
Uses of Psychological Tests 178
Limitations of Psychological Tests 179
Interpretation of Psychological Tests 179
Role of a Nurse in Psychological Assessment 179

9. Individual Differences 180

Meaning of Individual Differences 180
Types of Individual Differences 180
Causes of Individual Differences 181
Individual Differences in Health and Illness 182
Nursing Implications of Individual Differences 182

Glossary183
Question Bank 199
Bibliography219
Index221
 CHAPTER

Introduction to
Psychology 1
INTRODUCTION
Psychology is an offspring of subject philosophy.
Psychology is a Greek word, ‘psychi’ and ‘logos’.
‘Psychi’ means ‘soul’ and ‘logos’ means the ‘study of’
or ‘knowledge’—study of soul. The word soul was
used vaguely and there were many interpretations
that could be given to it. Later on, William James
used the term ‘mind’, which replaced ‘soul’. As years
Figure 1.1: Evolution of meaning of psychology
went by, the meaning of psychology changed. Those
who studied, what was called ‘mind’ found that only the overt behavior, but also the covert behavior
they could neither see it nor understand it. Seeing involving all the inner experiences and mental
what it did meant they had to study the activities of processes.
human beings. The influence of physiology made In a nutshell the term behavior refers to the
some scientists like Wilhelm Wundt of Germany entire life activities and experiences of all the living
define psychology as the study of ‘consciousness’. organisms (Table 1.1).
However, this was also discarded in the course of
time and the current definition of psychology, as the HISTORY AND ORIGIN OF SCIENCE OF
systematic study of human and animal ‘behavior’ PSYCHOLOGY
came to be accepted (Figure 1.1).
Psychology as a separate area of study, split away
from philosophy a little over 100 years ago. The
MEANING OF BEHAVIOR
successes of the experimental method in the physical
‘Any manifestation of life is activity’ and behavior sciences encouraged some philosophers to think that
is a collective name for these activities. The term mind and behavior could be studied with scientific
behavior includes the following: methods. In 1879, the first psychological laboratory
 Motor or conative activities (walking, swimming, was established at the University of Leipzig by the
dancing, etc.) German philosopher and psychologist Wilhelm
 Cognitive activities (thinking, reasoning, imagin­ Wundt (1832 – 1920). Wundt was the first to measure
ing). human behavior accurately and is known as the
 Affective activities (feeling happy, sad, angry, etc.) ‘Father of Psychology’.
Behavior includes not only the conscious William James, Wilhelm Wundt and other
behavior and activities of the human mind, but also psychologists of the time thought of psychology as
the subconscious and unconscious. It covers not the study of mind. In the first decades of the twentieth
2 Psychology for Nurses

century, psychologists came to hold quite different Functionalism

views about the nature of mind and the best way to Functionalists such as John Dewey (1873–1954),
study it. Schools of thought formed around these James R. Angell (1869–1949) and Harvey Carr
psychologists. These schools of thought are known (1873–1954) proposed that psychology should do
as the schools of psychology. “what mind and behavior do”. The functionalists
performed experiments on the ways in which
Structuralism learning, memory, problem solving and motivation
This early school of psychology grew up around help people and animals adapt to their environments.
the ideas of Wilhelm Wundt in Germany and was
established by one of Wundt’s students, Edward B. Behaviorism
Titchener (1867–1927). The goal of the structuralist This school of psychology originated with John
was to find the units or elements, which make up B.Watson (1879–1958). He insisted that psychology
the mind. The main method used to discover these should be restricted to the study of the activities of
elementary units of mind was introspection. people and animals—their behavior.

Gestalt Psychology Psychoanalysis

This school of psychology was founded in Germany Psychoanalysis was founded by Sigmund Freud
around 1912 by Max Wertheimer (1880–1943) (1856–1938). He developed a theory of behavior and
and his colleagues. These psychologists felt that mind, which said that much of what we do and think
structuralists were wrong in thinking of the mind, as results from urges or drives, which seek expression
being made up of elements. They argued that mind in behavior and thought. It is the expression of the
could be thought of as resulting from the whole unconscious drives which shows up in behavior
pattern of sensory activity and the relationships and and thought. The term unconscious motivation thus
organizations within this pattern. describes the key idea of psychoanalysis (Table 1.2).

Table 1.1: Major perspectives of psychology

Nature Explanation
Psychologists with a biological perspective try to relate people’s behavior and mental
Biological perspective events (as observed through their behavior) to functions of their bodies-especially to
the activity of their nervous and glandular systems
From the cognitive perspective, behavior and mind are to be understood in terms of
the ways in which information from the environment received through the senses is
Cognitive perspective
processed. Such processing is the basis of the experience. Differences in the way
we process information may lead to differences in behavior
Psychologists with a social perspective are interested in the interactions between
Social perspective
and among people, which influence the mind and behavior
Developmental The developmental perspective is concerned with characteristic changes that occur
perspective in people, as they mature and change in the way they think
The humanistic perspective emphasizes a person’s sense of self and each
individual’s attempts to achieve personal competence and self-esteem. The aim of
Humanistic perspective
humanism is to help each person attain his full potential in life or to become all that
he can become
The psychoanalytic (psychodynamic) perspective focuses on the unconscious
Psychoanalytic
motives and defence mechanisms, which manifest themselves in mental life and
perspective
behavior
 Introduction to Psychology 3
Table 1.2: Major landmarks in the development of psychology

Year Major landmarks

1879 Wilhelm Wundt inaugurates first psychology laboratory in Leipzig, Germany

1890 Principles of Psychology published by Williams James

1895 Functionalist model formulated

1900 Sigmund Freud develops the psychodynamic perspective

1904 Ivan Pavlov wins Nobel prize for work on fundamental principles of learning

1915 Strong emphasis on intelligence testing

1924 John B.Watson, an early behaviorist, publishes Behaviorism

Carl Rogers publishes Client-Centered Therapy, helping to establish the humanistic
1951
perspective
1953 B.F.Skinner publishes Science and Human Behavior, advocating the behavioral perspective
Abraham Maslow publishes Motivation and Personality, developing the concept of self-
1954
actualization
Leon Festinger publishes A Theory of Cognitive Dissonance, producing a major impact on
1957
social psychology
1985 Increasing emphasis on cognitive perspective

1990 Greater emphasis on multiculturalism and diversity

2000 New subfields develop such as clinical neuropsychology and evolutionary psychology

Except for the modern version of behaviorism and DEFINITIONS OF PSYCHOLOGY

psychoanalysis, the old schools of psychology are Psychology is the science of human and animal
no more in existence. Psychology today is practiced behavior; it includes the application of behavioral
as a blend of various methods. A modern day science to human problems.
psychologist leans towards using one of the methods Psychology is the science of human behavior.
more than the other, but depends on all that has been (Walter Bowers Pillsbury—1911)
developed in the past. Various viewpoints about Psychology is a science, which aims to give us better
what is important in understanding mental life and understanding and control of the behavior of the
behavior, characterize the present outlook. Among organism as a whole.
these perspectives are the behavioral, biological, (William McDoughall—1949)
cognitive, social, developmental, humanistic and Psychology is a science and the properly trained
psychoanalytic aspects. psychologist is a scientist or at least a practitioner,
Psychology is an independent subject and a who uses scientific methods or information resulting
positive science. Psychology is also a biosocial from scientific investigation.
science. It has an important relationship with both (NL Munn—1967)
biological and social sciences. It may be considered Psychology is the investigation of human and
as a link between the two groups. Study of psychology animal behavior and of the mental and physiological
is necessary in the field of medicine, nursing and processes associated with the behavior.
other areas of human endeavor. (Jackson—1976)
4 Psychology for Nurses

SCOPE OF PSYCHOLOGY and how they behave as members of small and

large groups.
The scope of a subject can usually be discussed  It employs to all the living creatures created by
under the following two headings: the almighty irrespective of their species, caste,
 The limits of its operations and applications.
color, age, sex, mental or physical state. Thus
 The branches, topics and subject matter with
normal, abnormal, children, adolescents, youth,
which it deals.
adults, old persons, criminals, patients, workers,
The field of operation and applications of the subject
officials, students, teachers, parents, consumers,
psychology is too vast.
etc. all are studied in the subject psychology.
 It studies, describes and explains the behavior of
 It also studies the behavior of the animals,
living organisms.
insects, birds and plant life.
 It describes all types of life activities and experi­
ences—whether conative, cognitive or affective, No limit can be imposed upon the scope of sub­
implicit or explicit, conscious, unconscious and ject psychology. It has many branches, fields and sub­
subconscious of a living organism. fields (Table 1.3). For convenience, it may be broadly
 It studies not only human behavior, but also divided into pure and applied psychology (Figure 1.2).
human experience, language and other forms of Pure psychology provides the framework and theory.
communication. Psychologists are interested in It deals with the formulation of psychological prin­
individual differences, either they be genetically ciples and theories. It suggests various methods and
determined or occurring as a result of learning. techniques for the analysis, assessment, modification
They study how individuals and society interact and improvement of behavior.

Figure 1.2: Branches of psychology

 Introduction to Psychology 5
In applied psychology, the theory generated Abnormal Psychology
through pure psychology finds its practical shape. Abnormal psychology deals with the behavior
Here we discuss ways and means of the applications of individuals who are unusual. It studies mental
of psychological rules, principles, theories and disorders, their causes and treatment.
techniques with reference to the real practical life
situations. Social Psychology
Branches of Pure Psychology Social psychology deals with the group behavior
and interrelationships of people with other people
General Psychology (how an individual is influenced by others and how
General psychology deals with the fundamental an individual influences others behavior). It studies
rules, principles and theories of psychology in various types of group phenomena such as public
relation to the study of behavior of a normal adult. opinion, attitudes, beliefs and crowd behavior. Social

Table 1.3: Major subfields of psychology

Subfield Description

Biopsychology examines how biological structures and functions of the body affect
Biopsychology
behavior

Clinical Clinical neuropsychology unites the areas of biopsychology and clinical psychology,
neuropsychology focusing on the relationship between biological factors and psychological disorders

Cognitive psychology Cognitive psychology focuses on the study of higher mental processes

Counseling Counseling psychology focuses primarily on educational, social and career adjustment
psychology problems

Cross-cultural Cross-cultural psychology investigates the similarities and differences in psychological

psychology functioning in and across various cultures and ethnic groups
Environmental psychology considers the relationship between people and their
Environmental
physical environment, including how our physical environment affects our emotions
psychology
and the amount of stress, we experience in a particular setting
Evolutionary Evolutionary psychology considers how behavior is influenced by our genetic
psychology inheritance from our ancestors

Experimental Experimental psychology studies the processes of sensing, perceiving, learning and
psychology thinking about the world

Forensic psychology focuses on legal issues, such as deciding on criteria for

Forensic psychology
determining whether a defendant was legally sane at the time a crime was committed

Health psychology explores the relationship between psychological factors and

Health psychology
physical ailments or disease

Personality Personality psychology focuses on the consistency in people’s behavior overtime and
psychology the traits that differentiate one person from another

School psychology is devoted to counseling children in elementary and secondary

School psychology
schools, who have academic or emotional problems

Sport psychology Sport psychology applies psychology to athletic activity and exercise
6 Psychology for Nurses

psychologists study the ways in which individuals in educational situations. The subject matter of this
are affected by other people. branch covers psychological ways and means of im­
proving all aspects of the teaching/learning process.
Physiological Psychology Educational psychologists are most often involved in
This branch of psychology describes and explains the increase in efficiency of learning in schools by
the biological and physiological basis of behavior. It applying psychological knowledge about learning
concerns the structure and functions of sense organs, and motivation.
nervous system, muscles and glands underlying all
behavior. It emphasizes on the influence of bodily Clinical Psychology
factors on human behavior. This is the largest subfield of psychology. This
branch of applied psychology describes the causes
Parapsychology of mental illness, abnormal behavior of a patient and
Parapsychology deals with extra-sensory perceptions, suggests treatment and effective adjustment of the
causes of rebirth, telepathy and allied problems. affected person in society.

Geopsychology Industrial Psychology

This branch of psychology describes and explains This branch of applied psychology tries to seek
the relation of physical environment particularly application of the psychological principles, theories
weather, climate and soil with behavior. and techniques for the study of human behavior
in relation to industrial environment. Industrial
Developmental Psychology psychologists apply psychological principles to
assist public and private organizations with their
This branch of psychology describes the processes
hiring and placement programs, the training and
and factors that influence the growth and development
supervision of their personnel and the improvement
in relation to the behavior of an individual from birth
of communication within the organization. They also
to old age. It is further subdivided into branches
counsel employees within the organization, who
like child psychology, adolescent, adult and old
need help with their personal problems.
age psychology. Development psychologists try to
understand complex behaviors by studying their
Legal Psychology
beginning and the orderly ways in which they change
or develop over the lifespan. Legal psychology is a branch of applied psychology,
which tries to study the behavior of persons like
Experimental Psychology clients, criminals, witnesses, etc. with the help
of applications of psychological principles and
This branch of psychology studies the ways and
techniques. The root cause of crime, offence, dispute
means of carrying out psychological experiments
or any legal case can be properly understood through
by using scientific methods. Experimental psycholo­
the use of this branch of psychology.
gists do basic research in an effort to discover and
understand the fundamental and general causes of
Military Psychology
behavior. They study basic processes such as learn­
ing, memory, sensation, perception and motivation. This branch of psychology is concerned with the
use of psychological principles and techniques in
Branches of Applied Psychology military science. How to keep the morale of the
soldiers and citizens high during war time, how to
Educational Psychology secure better recruitment of the personnel for the
Educational psychology is a branch of applied psy­ fighting capacities and organizational climate and
chology, which tries to apply the psychological prin­ leadership, etc. are the various topics that are dealt
ciples, theories and techniques to human behavior with in this branch of psychology.
 Introduction to Psychology 7
Political Psychology
This branch of psychology relates itself with the
use of psychological principles and techniques in
studying politics and deriving political gains.

Applications of Psychology
In the Field of Education
Theories of learning, motivation and personality,
etc. have been responsible for shaping and designing
the educational system according to the needs and
requirements of the students. The application of
psychology in the field of education has helped the
learners to learn, the teachers to teach, administrators
to administer and educational planners to plan
effectively and efficiently.
Figure 1.3: Application of psychology in various fields

In the Field of Medicine

In the Field of Military Science
A doctor, nurse or any person who attends the
patient, needs to know the science of behavior to Psychology helps in the selection, training, promotion
achieve good results. Psychology has contributed and classification of defense personnel. In fighting
valuable therapeutic measures like behavior therapy, the enemy, the morale of the defense personnel and
play therapy, group therapy, psychoanalysis, etc. for of citizens must at all costs be high and this can only
the diagnosis and cure of patients suffering from be achieved by providing suggestions, insight and
psychosomatic, as well as mental diseases. confidence.

In the Field of Business and Industry In the Field of Human Relationship

and Self-Development
It has highlighted the importance of knowledge of
Finally it has helped human beings to learn the
consumer’s psychology and harmonious interpersonal
art of understanding their own behavior, seeking
relationship in the field of commerce and industry.
adjustment with their self and others and enhancing,
as well as actualizing their potentialities to the utmost
In the Field of Criminology
possible (Figure 1.3).
It has helped in detection of crimes and in dealing
with criminals. RELEVANCE TO NURSING
In the Field of Politics Psychology has become necessary in every profession
including nursing today. This is because of increasing
It has proved useful to the politicians and leaders
emphasis being laid out on the interplay of body, mind
to learn the qualities of leadership for leading the
and spirit in the health status of every individual.
masses.
The success in life of many people depends on
how they get along with others, influence others and
In the Filed of Guidance and Counseling
react to others. The ability to understand ourselves
It has provided valuable help in relation to guidance and others comes from a wise study of psychology.
and counseling in educational, personal as well as The learning of psychology helps a nurse in the
vocational areas. following ways:
8 Psychology for Nurses

To Understand Her Own Self The knowledge of psychology helps the nurses in
The knowledge of psychology will help the nurse to recognizing mental illnesses at general hospitals and
get an insight into her own motives, desires, emotions, community health centers and provide appropriate
feelings, attitudes, personality characteristics and guidance to deal with stress, anxiety and other life
ambitions. She will realize how her personality problems.
is highly individualistic and complex, arrives at
decisions in her life and solves her own problems. To Understand Other People
This knowledge also helps her to understand her The student nurse has to study, work and live with
strengths and weaknesses. By knowing these aspects, other nurses, doctors, patients and their family mem­
she can not only try to overcome such weaknesses, bers. With her scientific knowledge of human nature,
which affect her work, but also develop good she will understand them better and thus achieve
personality characteristics, abilities to carry on her greater success in interpersonal relationships. She
responsibilities and perform her duties effectively will learn why others differ from her in their likes
and efficiently. This will let her direct her own and dislikes, in their interests and abilities or in their
life more productively and relate more easily with reactions to others. She will realize how differences
others, enabling her to control situations and attain in behavior to some extent, are due to differences in
self-discipline. customs and beliefs or cultural patterns of the groups
to which she belongs or to the way she has been
To Understand Patients brought up during her early years.
The nurses are professionals meant for providing
To Provide Quality Care to Patients
care to patients. The patient may be suffering from
acute or chronic disease; may be male or female, A nurse with good knowledge of human psychology
young or old and come to the hospital with so many can understand what fears or anxieties the patient
physical and psychological problems. They may also faces, what he feels, what he would like to know
have tensions, worries, pains and also many doubts and why he behaves the way he does. It will help
about their illness. The knowledge of psychology will the nurse to anticipate and meet requirements of
help the nurse to understand the problems and needs the patients and his relatives, thus help patients and
of patients and attend to them. She can understand relatives adjust to the unavoidable circumstances in
the motives, attitudes, perceptions and personality the best possible way. A good understanding of these
characteristics of patients in a better way. This will patients by the nurse can be of best support to him.
help the patient to attain quick relief and cure, which
is the basic motto of a nurse. Help Patients Adjust to the Situation
Illness and physical handicaps often bring about the
To Recognize Abnormal Behavior need for major adjustments. Many diseases such as
Psychology is relevant not only in physical health heart disease and cancer, etc. require special coping
care, but also highly relevant in the field of mental skills and health care. A nurse trained in psychology
health. Presently more and more people are suffering can be an effective health educator and help in these
from mental illness. While some patients may have kind of adjustments.
minor problems, others suffer with serious illness.
The knowledge of psychology will help nurses to Help the Student Nurse to Appreciate
understand abnormal behaviors and help the patient the Necessity for Changing the
in management of mental illnesses. Nurses working Environment or Surroundings
in mental hospitals definitely need an adequate Good nursing care depends upon the ability of a
knowledge of normal and abnormal psychology. nurse to understand the situations properly and
 Introduction to Psychology 9
also in obtaining the cooperation of other people different problems both physical and mental. To
concerned. The change in the environment is serve them satisfactorily, knowledge of psychology
sometimes necessary for better adjustment and is quite essential.
happiness. For example, a boy who is completely
denied the affectionate care of his parents may do METHODS OF PSYCHOLOGY
better if he is given the care of foster parents.
Psychology is termed as the scientific study of human
Help for Effective Studying behavior. Special tools and procedures help us in
gathering and organizing its subject matter or the
The nurse has to learn many new things during her
essential facts about behavior. These procedures are
training. She has to obtain the knowledge of correct
termed as methods, which are used to study human
facts about disease conditions and their treatment.
behavior (Figure 1.4). They are as under:
The study of psychology of learning will help the
nurse to acquire knowledge in an effective way.
Introspection or Self-observation
Readjustment Method
Every profession and career requires readjustment. This is one of the oldest methods of psychology.
A nurse needs to make the following kinds of Introspection means ‘to look within’. This is also
adjustments for success in the nursing career: known as self-observation method. It is not possible
 Overcoming homesickness and self-reliance is to understand the inner feelings and experiences
needed if she has to live smoothly in a hostel or a of other persons. Here the subject is asked to
hospital. systematically observe his own behavior and
 Adjusting to sick persons, who may cry or be report the same; this is later analyzed to understand
desperate or even ventilate their anger by making behavior. For example, a patient after an operation
the nurse a target of their abuses and curses. may be asked to report how he feels. The patient will
 Trying to work and study together. try to look within and recall what happened and how
In these efforts knowledge of psychology can be he is presently feeling. This information will help for
helpful, as an insight into the emotions will clear lots better treatment. This is the characteristic method of
of problems. The well-being of a patient is the prime psychology, which is not available to other natural
responsibility of a nurse. She must not only treat him sciences.
physically, but also instill confidence in his capacity
to improve and recover fully. For this, knowledge Merits
of human psychology is essential. The physical and  Introspection is the fundamental method of
mental well-being of a patient mainly depends on the psychology. Observation and experimentation
nurse. She has to deal with different people having are based upon introspection.

Figure 1.4: Methods of psychology

10 Psychology for Nurses

 Introspection gives us direct, immediate and Merits

exact knowledge of our own mental processes.  It is economical, natural, as well as flexible.
 It enables us to fully understand the behavior of  The data, which is studied through observation
an individual. can be analyzed, measured, classified and inter­
 This method is inexpensive, easy and does not preted.
require any apparatus or laboratory.  The results can be verified and relied.
 Observation method is quite suitable for observ­
Demerits
ing developmental characteristics like children’s
 This method is not applicable for children or habits and interests. For example, the effect of
animals or mentally retarded people, because absence of a mother or father or both on the
they cannot introspect. child’s development can be determined properly
 It is a purely private affair and cannot be verified through observing the development of such de­
by other observers. prived children.
 In many cases, the patients may not have
the insight to know about their conditions or Demerits
language to describe them accurately.
 Introspection sometimes involves attention to a  There are chances of subjective report and also
mental process (Example: perception), which is prejudices of observer may creep in.
produced by an external object. When we attend  Sometimes to observe the natural behavior the
to the mental process, we withdraw attention from observer may have to spend more time, energy
the object and as soon as we withdraw attention and money.
from the object the mental process vanishes, thus  It lacks repeatability, as each natural situation
making introspection impossible. can occur only once.
All the difficulties of introspection can be  Not being able to establish a proper cause-and-
overcome by habit and discipline of mind. It requires effect relationship.
a power of abstraction and mental alertness. The difficulties of observation method are over­
come by cultivating an impartial attitude of mind, by
Observational Method constructive imagination and cautious observation.
Observation is the objective method of studying the
behavior of individuals. It consists of, perception of
Experimental Method
an individual’s behavior under natural conditions Experimental method is considered as the most
by the other individuals and the interpretation and scientific and objective method of studying
analyzes of this perceived behavior by them. It is behavior. The word experiment comes from a Latin
essentially a way of perceiving the behavior as it is. word meaning ‘to try’, ‘put to test’. Therefore, in
In this method the observer observes and collects experimentation we try or put to test the material or
the data. Example, in the hospital the nurse makes phenomenon, the characteristics of consequences of
an observation of patient’s temperature, pulse, blood which we wish to ascertain. The use of this method
pressure, facial expressions, restlessness, etc. to has raised psychology to the status of an experimental
understand clinical condition of the patient. science like physics, chemistry and physiology.
In psychology, experimental study is used to
Steps in Observation Method study the cause-and-effect relationship regarding the
 Observation of behavior nature of human behavior, i.e. the effect of anxiety
 Noting of behavior on the human behavior. To study the cause-and-
 Interpretation and analysis of behavior effect relationship the psychologists use objective
 Generalization observations under controlled conditions to observe
 Introduction to Psychology 11
actions or behaviors of individuals. From these  Testing of the hypothesis by the result of
observations certain conclusions are drawn and experiment: The results may prove or disprove
theories or principles established. the hypothesis.
The various steps involved in experimental
Essential Features of Experimental Method method have been depicted by way of a flow chart
 Requires two persons, the experimenter and the (Figure 1.5).
subject or the person, whose behavior is observed.
 Experimentation should be done on living Merits
organisms.
 Scientific method
 All experiments are conducted under controlled
 Finds out cause and effect relationship
conditions.
 Maximum control of phenomena
 Repetition is possible
Steps in Experimentation
 Stating the problem: The first step in an Demerits
experiment is stating the problem. For example,
to study the effects of smoking on physical and  All problems of psychology cannot be studied by
mental health of students. this method, as we cannot perform experiments
 Formulation of hypothesis: Hypothesis is a for all the problems.
tentative answer to the problem. For the above  Experimental method is a costly and time
example, the hypothesis can be–smoking is consuming method. Moreover handling of this
harmful for physical and mental health of method demands specialized knowledge and
students. This hypothesis will be tested. skill. In the absence of such expertise this method
 To find out independent and dependent variables: is not functional.
The effect of which we want to study will be
called independent variable and the other the
dependent variable. The independent variable
stands for the cause and dependent variable is
characterized as the effect of the cause. In the
above example physical and mental health will
be dependent variables and smoking will be an
independent variable.
 Arranging the environment: Under controlled
environment the variables are objectively ob­
served. For example, physical and mental health
of students (who are smoking) will be observed. In
experimentation, it is important that only the spec­
ified independent variables be allowed to change.
Factors other than the independent variable must
be held constant.
 Analysis of the results: Generally the subjects of
the experiment are divided into two groups, one
controlled and the other experimental. They can
be compared statistically. For example, smoker’s
and non-smokers mental and physical health can
Figure 1.5: Various steps of experimental method
be compared.
12 Psychology for Nurses

 Experimental method fails to study behavior in Survey Method

naturalistic conditions. All problems in psychology cannot be studied by
 It cannot always be used especially if the the experimental and other methods. Some problems
experiment might be dangerous to the subjects. like study of opinions, attitudes, health care needs,
In spite of various limitations it is a fact that, etc. can be studied by means of survey method. This
the results obtained by experimental method are is commonly employed in social psychology.
reliable, verifiable, definite, precise and capable of The survey method involves collection or gather­
quantitative treatment than those obtained by the use ing of information from a large number of people by
of other methods. using questionnaires, inventories, checklists, rating
scales and interviews.
Clinical or Case History Method
This method is used by clinical psychologists, Merit
psychiatrists, psychiatric social workers in child A large amount of data can be collected in a shorter
guidance clinics or mental hygiene clinics and the time.
allied institutions. It aims at studying the cause
and basis of people’s anxieties, fears and personal Demerit
maladjustments. A great deal of relevant data is
The behavior is not observed directly.
collected by using case histories, interviews, home
visits and psychological tests to draw valid inferences
Genetic or Developmental Method
about the nature of the individual’s difficulties
and problems, the probable origin and course of Psychologists study not only the behavior of
development. This may suggest some course of an individual at a particular time, but also his
action to be pursued in helping the individual. development from birth to death, the influence of
In this technique information is collected from heredity and environment in the development of the
the memory of the individual, his parents, members person and conditions favorable and unfavorable
of his family, friends, teachers and all other available for normal and abnormal behavior. For example,
records and reports. The information includes the to understand the learning behavior of an adult, the
past history of the disease, treatment already taken, study will start from the childhood and adolescence.
changes if any like improvement, present condition, This can be done by two ways:
probable causes, signs and symptoms, etc.  Cross-sectional study in which, the children of
different age groups will be studied simultane­
Merits ously.
 Longitudinal study in which, the same child will
 Case histories will give the clinician an insight
be studied in different stages of life.
into the causes of the problem and suggest
possible solutions.
Merits
 Case studies can be productive sources of ideas
for further investigation by other methods. This is a more useful method to understand the
behavior from point of view of hereditary and
Demerits environmental influences.
The case history method depends largely on memory
Demerit
of incidents, which may have been observed inac­
curately or over interpreted. This method requires more time and energy.
 Introduction to Psychology 13

REVIEW QUESTIONS 6. Explain case study method. (Aug 2009)

7. Explain the relevance of psychology to nursing.
(Aug 2009)
Long Essays 8. Explain experimental method in psychology. (Mar
1. Define psychology and explain in detail the methods 2012, April 2008)
in psychology. (Mar 2012) 9. Bring out the similarities and differences between
2. Define psychology. Explain methods of observation introspection and observation. (April 2008)
and case study. (Mar 2009) 10. What is the general importance of psychology?
3. Define psychology. Explain its nature and scope Why should a student nurse study psycho­ logy?
with reference to nursing. (Mar 2009) (Oct 2007)
4. Discuss various methods of psychology used to 11. Discuss the scope of psychology. (Apr 2006)
study the behavior. (Oct 2007) 12. Define psychology. What are the different methods
5. Define psychology and explain its nature and scope used in the study of psychology? (2004)
with special reference to nursing. (Mar 2012, Oct 13. Discuss introspection its advantages and limitation
2007, April 2006, 2004, Nov 2003) as a method of psychology. (Nov 2003)
6. Critically examine observation method and experi­
mental method—explain. (April 2005) Short Answers
7. Define psychology. What are the different methods
used in the study of psychology. Critically evaluate 1. Write any two definitions of psychology. (Mar 2012)
them. (Mar 2004) 2. Child psychology. (Aug 2010)
3. Methods of psychology. (Mar 2009)
4. Define any two branches of psychology. (Mar 2009)
Short Essays 5. Case history method. (April 2008)
1. Explain any two branches of psychology. (Mar 2012) 6. List the branches of psychology. (Oct 2007)
2. Scope of psychology in nursing profession. 7. Behavior. (Oct 2007) (Nov 2003)
(Mar 2011) 8. Interview method. (Oct 2006)
3. Case study method. (Aug 2010) 9. Experimental method. (April 2005)
4. Relevance of psychology to nursing. (Mar 2009) 10. What is introspection? (2004, Nov 2003)
5. Describe merits and demerits of experimental 11. Observation method. (2004)
method. (Mar 2009) 12. Definition of psychology. (Nov 2003)
 CHAPTER

Biology of
Behavior 2
The biology of behavior is the study of behavioral ™™ Body is represented by physical states and bodily
functions of the nervous system, particularly the functions. Our nervous system and glands, which
brain. ‘Physiological psychology’ is the branch of are an important part of our body are responsible
psychology, which seeks to determine how activity for our ways of thinking, feeling and doing.
in the nervous system is related to behavior and the ™™ All behaviors have an anatomical and physiolog-
mind. ical basis. Physiological structures, body fluids,
Many aspects of human behavior and mental chemicals and mechanical events, all influence
functioning cannot be fully understood without some both our overt behavior and our feelings and
knowledge of the underlying biological processes. experiences. Our mental functions like strong
Our nervous system, sense organs, muscles and feelings, emotions, attitudes, motives, thinking,
glands enable us to be aware of and adjust to our etc. influence our bodily activities and processes.
environment. Our perception of events depends on ™™ Emotions are combination of bodily responses
how our sense organs detect stimuli and how our and mental processes. Body provides energy
brain interprets information originating from the to fight or cope; mind contributes to the
senses. understanding, to offer an explanation for ones
own actions or the actions of others. Just as
BODY-MIND RELATIONSHIP— the body produces epinephrine to fight danger,
MODULATION PROCESS IN HEALTH the mind helps to decide, whether it is needed
AND ILLNESS or not.

™™ Psychology studies human behavior, which Effects of Bodily Conditions on Mental

involves both the body and the mind. They are
Functioning
interrelated and interact upon each other. Mental
functions and physical states affect each other. ™™ Increased blood pressure causes mental excite-
™™ Body and the mind are two aspects of the living, ment.
dynamic and adjusting personality. Mind is ™™ Severe pain reduces the concentration level.
regarded as a function of the body; it does not ™™ Chronic illness causes depression.
exist apart from the body. It is the sum total of ™™ Malfunctioning of the endocrine glands may
various mental processes such as observing, exert full influence on one’s personality, resulting
knowing, thinking, reasoning, feeling, imagining, in lethargy, nervous tension, etc.
remembering, judging, etc. Mind also grows just ™™ Physical fatigue affects our mood and reduces
as the body grows. our motivation, interest and concentration.
 Biology of Behavior 15
™™ Brain injury affects many psychological func- GENETICS AND BEHAVIOR:
tions. At the same time well developed brain HEREDITY AND ENVIRONMENT
leads to the development of better intellectual
functioning.
Heredity
Heredity is considered as “the sum total of inborn
Effects of Mental Conditions on Bodily
individual traits”. Biologically, it has been defined
Functioning as “the sum total of traits potentially present in the
™™ Unpleasant emotions like fear, anger and worry fertilized ovum”. According to Douglas and Holland
cause irritability, insomnia, headache, etc. “one’s heredity consists of all the structures, physical
Mental processes are intimately connected to characteristics, functions or capacities derived from
brain or cortical processes, e.g. depression affects parents, other ancestry or species”.
thinking and memory. All organisms possess a life cycle, which in-
™™ Emotional conflicts are responsible for peptic cludes growth, development, reproduction and de-
ulcer, ulcerative colitis, etc. cline. Though there is essential unity in life, the ways
™™ Deep thinking and concentration can cause by which each organism exercises its capacities are
physical strain. different. These individual qualities of organisms
™™ According to Franz Alexander, repressed feel-
and their basic properties are transmitted by means
ings of hostility and aggression are expressed of heredity.
through the nervous system and cause hyperten-
Mechanism of Heredity
sion and cardiac diseases. Repressed feelings of
dependency, wish to receive love, affect para- The life cycle of an individual begins with the fusion
sympathetic nervous system resulting in gastro- of a sperm and ovum. The origin of every human life
intestinal disorders or respiratory disorders. can be traced to a single cell called zygote. When
™™ Unconscious motivation and conflicts gives a sperm unites with an ovum, zygote is produced.
rise to many physical complaints and neurotic The genes, which are the carriers of distinctive traits
disorders like conversion disorders. are present both in the sperm and the ovum. In the
Relationship between body and the mind has fertilized ovum, there are 23 pairs of chromosomes,
an effect on health and illness. If the relationship half of which are given by the father and the other
is harmonious, it leads to health, while an adverse half by the mother. While females have 23 pairs
of XX chromosomes, males have 22 pairs of
relationship leads to illness. If all the body and
XX chromosomes plus two single chromosomes
mental processes are working within normal range,
represented by X and Y. The X and Y are called as
the individual will have good health. Disruption in
sex chromosomes.
any one of the processes will lead to illness.
Occasionally, through some unfortunate bodily
Psychosomatic medicine deals with physical
error, aberrations in chromosomes appears. If an
diseases caused by psychological factors. In these
extra chromosome appears making the total 47
patients, the treatment should be given for both body rather than the normal 46, mongolism (Down’s
and mind, e.g. in case of peptic ulcer the treatment syndrome or trisomy 21 anomaly) results. A child
includes both drugs and psychotherapy. with Mongolism suffers from deceleration of growth
The nurse should understand the interrelationship during the prenatal period, which results in a highly
between the body and the mind. She should also complex, multidimensional disorder, in which every
understand the emotional factors underlining the organ is involved.
disease of the patient. It is always necessary to study When chromosomes are studied under a micro-
the patient’s physical and psychological problems in scope, bands of markings appear, representing an
order to provide comprehensive care. entity called genes, which appear to be the actual de-
16 Psychology for Nurses

terminers of traits. Each chromosome is made up of introduction of completely new traits in the next
many genes. Man has probably not less than 2,000 generation. Such changes are called mutations.
and not more than 50,000 genes in the chromosomes. Mutant plants and animals might have characteristics
Each gene is the determiner of a specific character- that breeders can use to improve existing varieties.
istic, such as straight nose or a deep lobed ear. At In human beings, mutations are almost always
present, it appears that, there is no simple one-to-one undesirable. Their causes are not clear, but are known
relationship between genes and traits, i.e. one gene to be induced by atomic radiation.
may influence many characteristics or traits or con- Heredity is the basis for the development of
versely many genes may combine to determine one human personality. It is like the raw material in the
characteristic. hands of the artist, out of which the potter or tailor
Action of the genes on the cytoplasm changes prepare the specific objects. Any amount of molding
the shape and other characteristics of the cells. The and treatment with special processes will still retain
heredity basis of individual differences lies in the the basic properties of the raw material.
unlimited variety of possible gene combinations Many aspects of human behavior and develop-
that can occur. No two siblings get an identical ment range from physical characteristics such as
heredity, as they do not get the same genes from height, weight, eye and skin color. The complex
the parents. Fraternal or dizygotic twins born to the patterns of social and intellectual behavior are in-
same parents are different from each other, because fluenced by person’s genetic endowment. They
of different pairs of germ cells. However, identical also include physical deficiencies and the nature
or monozygotic twins develop from the same sperm of glandular functioning. Heredity is a source of
and ovum, hence have exactly the same set of genes both similarities and differences among individuals
and therefore, resemble each other completely. (Table 2.1).
Determination of traits is not only due to
combination of genes, but also due to their dominant Table 2.1: Characteristics influenced significantly by
or recessive nature. In the color of the eye, e.g. genetic factors
brown is dominant over blue, if one parent carries Emotional
Physical Intellectual
only brown and the other only blue, their offspring characteristics characteristics
characteristics
will have brown eyes. Many people however, carry and disorders
both and if two recessive blues happen to match up Height Memory Shyness
in the assorting process of meiosis and fertilization, Weight Intelligence Extraversion
the child would have blue eyes even though parents
Obesity Age of Emotionality
and all the immediate relatives have brown eyes. language
Some characteristics are sex linked, i.e. one acquisition
sex shows the characteristics, while the other sex
Tone of voice Reading Neuroticism
not apparently affected is the carrier. One such disability
trait is color blindness. For example, the sons of a
Blood Mental Schizophrenia
color blind man and normal woman do not inherit pressure retardation
the defect, but the daughters may be carriers of the Tooth decay Anxiety
disorder to another generation of males, their sons.
Athletic ability
Another example is hemophilia; a bleeding disorder,
which rarely occurs in women, but is transmitted by Firmness of
handshake
them to their sons (Stern, 1960).
Age of death
Occasionally, in the reproductive cells of any
living thing a change occurs, which causes the Activity level
 Biology of Behavior 17
Environment surrounded by amniotic fluid and attached to the
The child inherits the traits and characteristics of his mother by the umbilical cord. Thus, growth of the
parents and forefathers through genes at the time of embryo depends on the nourishment provided by
conception. Therefore, what he possesses at the time the mother. The physiological and psychological
states of the mother during pregnancy, her habits and
of conception is all due to heredity.
interests, etc. all influence the development of the
After conception, how he develops is the out-
child.
come of the interaction between his heredity and en-
After birth, the child is exposed to the numerous
vironment. The forces of environment begin to play
environmental forces, which are purely external in
their part and influence the growth and development
nature.
of an individual right from the time of fertilization
of the ovum by the sperm. Therefore from the envi- External environment: It can be divided into three
ronmental point of view, not only what happens after kinds:
birth is important, but what goes on inside the womb  Physical environment
of the mother after conception is equally significant.  Biological environment
Environment covers the social, moral, economi-  Psychosocial environment
cal, political, physical and intellectual factors, which Physical environment: Non-living things like water,
influence the development of the individual from air, housing, soil, climate, heat, light, radiation,
time to time. noise, etc. form the physical environment. These
affect the body and mind of the growing child. So,
Definitions it is necessary to provide a decent home and locality
The environment is everything that affects the for good physical and mental health of the child.
individual except his genes.
Biological environment: It refers to the living
(Boring, Langfield and Weld)
component of man’s external environment, which
Environment covers all the outside factors that
consists of plants, animals, insects, bacteria and
have acted on the individual, since he began life.
viruses. It is necessary that the child should be allowed
(Woodworth)
to grow in a good, healthy biological environment.
The child should be kept away from the disease
Types of Environment carrying germs, bacteria and viruses.
There are three types of environment that affect the
individual directly or indirectly: Psychosocial environment: It includes cultural val-
ues, customs, habits, beliefs, attitudes, morals,
 Intercellular environment
religion, education, occupation, social and political
 Intrauterine environment
organization, etc. Parents, members of the family,
 External environment
friends, classmates, neighbors, teachers, mass com-
Intercellular environment: It relates to embryonic munication and recreation are also included in this
development. The cytoplasm is in the intercellular environment. These different environmental forces
environment, because the genes surrounded by it are have a desirable impact upon the physical, social,
influenced by and in turn influence its characteristics. emotional, intellectual, moral and aesthetic develop-
Endocrine glands and hormones also produce ment of an individual. Their influence is a continu-
intercellular influence. Many congenital deformities ous one, which begins with the emergence of life and
are the result of overactive or underactive endocrine goes on till death.
function. One example of the influence of environment
upon potential height is found among the first and
Intrauterine environment: It shelters the baby during second generations of Japanese people in the United
prenatal life. In the womb the growing organism is States (US). The children are generally taller than
18 Psychology for Nurses

their parents, because they have had the advantages interaction of heredity and the environment. Within
of better food and better living conditions. Another this interaction, our genetic endowment for many
example is the children of third world countries characteristics provides us with a reaction range of
whose growth and development have been stunted possible levels that we may ultimately reach depending
by drought and famine. As food becomes available, on the quality of our experience in the environment.
many of these children show marked improvement Heredity and environment are interdependent forces.
in their physical conditions. The influence of heredity and environment are so
interrelated that they are practically inseparable.
Interaction Between Heredity and The knowledge of the mechanism of heredity
Environment and the influence of environment on the personality
development is important for a nurse to understand
Each individual enters the world with certain the behavior of a patient.
hereditary characteristics transmitted to him through
his parents. He grows up in a certain environment
with its human, social and material surroundings. BRAIN AND BEHAVIOR: NERVOUS
Everything he does as a child or adult results from SYSTEM, NEURONS AND SYNAPSE
the complex interactions between heredity and
™™ The entire behavior is effectively managed and
environment.
controlled by the coordination and functioning of
™™ The relative influence of heredity and environ-
ment differs from one individual to another and the nervous system.
from one human trait or condition to another. ™™ How we will behave in a particular situation
™™ Heredity and environment are interdependent
depends upon the judgment of our brain.
forces. Inheritance is an important factor in the ™™ The sense impressions, which are received
development of the artistic abilities like music. through the sense organs, do not bear any
Heredity supplies the potential talent, while significance unless they are given a meaning by
favorable environment brings it out. the nervous system.
™™ Heredity and environment are equally important ™™ Learning also to a great extent is controlled by
in shaping the temperament of the child. Heredity the nervous system.
lays down the essential foundations, while ™™ The proper growth and development of nerve
environment can change these foundations for tissues and nervous system as a whole helps in
better or worse. the task of proper intellectual development.
™™ Heredity provides the raw material from which ™™ Any defect in the spinal cord or the brain
a person is made. How the material is molded, seriously affects the intellectual growth.
and what he becomes depends chiefly on the ™™ The emotional behavior is also influenced by
environment. Good materials placed in good the nervous system, especially at the time of
hands result in a fine finished product. Poor anger, fear and other emotional changes. During
material, no matter how carefully fashioned can emotional outbursts, nerve tissues cause the
never become a first rate product. change in the secretion of hormones by some
™™ Our inheritance prescribes the limits, beyond glands and consequently influence the emotional
which it may not be possible for any individual behavior of an individual.
to develop, however wholesome and stimulating ™™ The process of growth and development is
the environment may be. also directly and indirectly controlled by the
Today no one believes that nature or nurture alone, functioning of the nervous system.
completely determines the course of our development. ™™ The personality of an individual is greatly influenced
Psychologists agree that development is shaped by the through the mechanism of the nervous system.
 Biology of Behavior 19
Through its receptors, the nervous system keeps Internal Receptors
us in touch with our environment, both external and Internal receptors are associated with the internal
internal. Like other systems in the body, the nervous stimuli present in our body. They are responsible for
system is composed of organs, particularly the feelings of pain, hunger or nausea. Another variety
brain, spinal cord, nerves and ganglia. These in turn, of these internal receptors helps us in maintaining
consist of various tissues, including nerve, blood balance, bodily posture and equilibrium and also
and connective tissues. Together these carry out the exercise control over the muscles.
complex activities of the nervous system.
Human behavior involves the body-mind
Sensation
interaction of the various bodily factors. The most
important are: Most of our behavior is dependent upon what our
 The sense organs, called receptors. senses tell us. Vision, hearing, taste, smell and touch
 The muscles and endocrine glands, called effectors. are called five senses. The functioning of the five
 The nervous system known as the connecting or senses is called sensation. Sensations are purely the
integrating mechanism. result of physical stimuli operating on our nervous
system.
Receptors (Psychology of Sensations) Sensory experience: Each sensory system is a kind
Behavior in all its forms and shapes has definitely of a channel, consisting of a sensitive element (the
a biological or physiological base. The behavior is receptor). The nerve fibers connect these receptors
based on the various stimuli present in the external to the brain or spinal cord, various relay stations and
environment and lying within our body. The stimuli processing areas within the brain. When a sensory
in the form of various sensory experiences are channel is stimulated, we have a sensation that is
received by our sensory systems known as receptors. characteristic of that channel. For instance, whether
the eye is stimulated by light or by pressure on the
External Receptors eyeball, we have a visual experience. In order to
know about the world around us, physical energy
External receptors are those sensory mechanisms
must be converted into activity within the nervous
that help us make contact with the outer world, for
system. The process of converting physical energy
example, eyes, ears, nose, tongue and skin. The
into activity within the nervous system is called
specific receptor cells for receiving the external
transduction. Transduction occurs in the receptor
stimuli lie within these sensory systems.
cells. During the transduction process, receptor cells
Sense organs: convert physical energy into an electric voltage or
™™ Our sense organs help in assimilating knowledge potential, called the receptor potential. In some
of the world around us. Each of our sense organs sensory systems, the receptor potential itself directly
has a distinct function to perform. triggers the nerve impulses that travel to the brain
™™ Sense organs consist of receptors, which are or the spinal cord. In other sensory systems, the
specialized sensitive cells associated with receptor potential leads to further electrical events,
endings of sensory nerve fibers. These receptors which in turn trigger nerve impulses. This is known
are stimulated by objects outside the body and as the ‘generator potential’.
also by internal conditions. For any event in the environment, thousands of
™™ When the receptors are not functioning properly, nerve impulses are generated and conducted to the
they lead to sensory defects or disorders—visual, central nervous system. Since, these impulses travel
auditory, cutaneous, olfactory, gustatory and along many different nerve fibers at slightly different
kinesthetic disorders. times, they form a pattern of input to the central
20 Psychology for Nurses

nervous system that is the basis for our sensory treating or using treatments or applications of any
experience of the event (Figure 2.1). kind. Bandages, adhesive tapes, plaster casts, heat
Sometimes our sensations are not accurate or cold, even wrinkled linens may be very irritating
because our sense organs or parts of the nerve to a patient. Gentle skin care is necessary to prevent
complexes, which produce sensations are abnormal, irritation. Patients always should be handled gently
sick or injured. When this happens, the information and smoothly to avoid pain and discomfort.
we receive is inaccurate and our responses become In health-care environment, the possible sources
abnormal. for bad odor are: body eliminations, treatment
procedures, dressings, drainages and medications.
Nursing Implications of Sensory Process These must be controlled as much as possible by
The nurse always has to be alert to malfunctioning proper ventilation and prompt disposal of waste.
of sense organs and abnormal sensations in patients. A sick person may not relish his food. Taste can be
A sick person reacts to colors. There are some improved with good mouth care and well prepared,
colors, which are soothening. During illness even clean and fresh food served in an appetizing way.
moderate lighting may irritate and cause discomfort. Those who have dizziness may need help in walking
For patients, who need rest and sleep lights can be and protection from accidents and injury. Rough, fast
subdued. For stimulation and encouragement, warm or jerky movements cause discomfort and irritation
bright lights can be used. An ageing patient may need to the patient. Patients should always be handled
a great deal of help than younger patients in order to gently and smoothly to avoid discomfort.
see visual details. The nurse can use her knowledge concerning
A sick person is very much averse to loud noises. the sense organs for her sense training, so that her
It increases the patient’s irritability. The nurse must sensory organs may be trained for observations
avoid loud noises in the ward. Patients with hearing concerning her functions.
loss require special effort by the nurse to be sure that
the instructions are given clearly and questions are Effectors (Muscular and Glandular
answered and understood. Controls of Behavior)
Patients with loss of skin sensation require special Effectors are termed as the organs of responses.
attention to prevent further injuries to the skin, while What is received through the sensory organs in the
form of sensory input is responded through bodily
reactions and motor activities carried out through
muscles and glands, particularly the hormones se-
creted by the ductless glands, which are responsible
for most of our behavior patterns. The underactivity
or overactivity of these glands, causes deficiency or
excess of hormonal secretion. This affects the entire
personality makeup of the individual.

Muscles
Our behavior and activity involves movement of dif-
ferent parts of our body. Muscles help the organ-
ism to carry out motor activities in order to respond
to various stimuli. There are mainly three types of
muscles, viz. smooth muscles, cardiac muscles and
skeletal muscles. Smooth muscles are primarily con-
Figure 2.1: Schematic representation of sensory cerned with the process of digestion, excretion and
experience blood circulation. Their contraction and relaxation
 Biology of Behavior 21
produce constriction and dilation of blood vessels, The functioning of all the endocrine or ductless
thus increasing or decreasing blood pressure. glands exercises a great influence on the various
Cardiac muscles function smoothly in a rhythmic aspects of growth and development of human
fashion, but when one is emotionally upset, their personality. The underactivity or overactivity of
normal functioning is disturbed causing heart trouble. these glands caused by the deficiency or excess of
Skeletal or striped muscles enable the individual the hormones secreted by them, affects not only
to perform voluntary motor activities ranging from the growth and development of the individual, but
walking to the fine psychomotor skills like typing, etc. also the entire behavior. A slight imbalance, of the
hormones may cause unusual restlessness, anxiety
Glands and weakness. Our physical strength, thinking and
Glands play an important role in human behavior. reasoning powers and decision making ability all
They also assist in the digestion of food, elimination depend upon the health of the glands (Figure 2.2).
of waste products, production and prolongation of
emotional states and regulation of metabolism of the Connectors
body. There are two types of glands:
 Duct glands Connectors or adjusters help in regulating, control-
 Ductless or endocrine glands ling or coordinating the activities of receptors and
effectors. The ability to play a piano, drive a car or
Duct glands release their chemical secretion through hit a tennis ball depends on muscle coordination. It
little ducts or tubes into the body cavities or on the is necessary for the body to provide messages to the
surface of the body. Some of the duct glands are: muscles to coordinate. These messages are passed
™™ Salivary glands through specialized cells called ‘neurons’.
™™ Gastric glands
™™ Sweat glands
™™ Lacrimal glands
™™ Kidneys
™™ Sex glands
The duct glands either become overactive or
underactive, under the influence of emotions. There
is a close and intimate connection between human
behavior and the secretions of duct glands.
Ductless or endocrine glands secrete chemical
substances called hormones. The hormones are
released into the blood stream and are carried to
all parts of the body. They play a vital role in the
determination of human personality. They affect
the development of the body, general metabolism,
mental development, development of secondary
sex characteristics and emotional behavior. The
endocrine glands are:
™™ Pituitary gland
™™ Thyroid gland
™™ Parathyroid gland
™™ Adrenal glands
™™ Male sex glands or gonads
™™ Pancreas Figure 2.2: Location of major endocrine glands
22 Psychology for Nurses

Neuron
™™ A nerve cell with all its branches is called a
neuron. These are the basic elements of the
nervous system.
™™ A neuron has a nucleus, a cell body and a cell
membrane to enclose the whole cell. There are
tiny fibers extending out from the cell body
called ‘dendrites’.
™™ Their role is to receive messages through
electrical impulses from the sense organs or
adjacent neurons and carry them to the cell body.
™™ The messages from the cell body further travel
the length of a nerve fiber known as the axon
(Figure 2.3).
™™ A group of axons, bundled together like parallel
wires in an electrical cable, is referred to as a
nerve.
™™ The axon (but certainly not all of them) is
surrounded by a fatty covering called the ‘myelin Figure 2.3: Structure of neuron
sheath’. It serves to increase the velocity, with
which the electrical impulses travel through the ™™ There is a fluid-filled space called the synapse
axons. between the axon of the neuron and the receiving
™™ There are three types of neurons. dendrite of the next neuron.
 Sensory neurons—they help in the process of ™™ Enlargements of the axon endings of transmitting
sensation and perception. neurons called boutons, contain neurotransmitter
 Motor neurons—they are responsible for chemicals, which are stored in small vesicles.
physical movements and activation of glands. ™™ A nerve impulse reaching these boutons causes a
 Interneurons or association neurons—they neurotransmitter to be released into the synapse.
carry signals in the form of memories and With the help of the release of a neurotransmitter
thoughts and add reflex or automatic activi- into the synapse, one neuron is capable of sending
ties. its message on to many other neurons.
™™ It makes it possible for a single neuron to receive
Neural Impulse messages from thousands of other neurons.
™™ Neurons are the receivers and transmitters of
messages. These messages are always in the Synapse
form of electrochemical impulses.  Information is transmitted through the body from
™™ A neuron in its resting position is supposed to one neuron to another. The junction between two
maintain a sort of electrical equilibrium, i.e. state neurons is called a synapse.
of polarization. This state of polarization may be  The small space between the axon terminals of
disturbed on account of the effect of trigger-like one neuron and the cell body or dendrites of
action of a stimulus applied to the membrane. another is called the synaptic cleft.
It causes a sudden change in the electrical  Neurons conducting impulses toward the syn-
potentiality of the neuron. It gets depolarized and apse are called presynaptic neurons and those
neural impulse is initiated. These impulses are conducting impulses away are called postsynap-
carried along the neuron axons. tic neurons.
 Biology of Behavior 23
 A chemical, called a neurotransmitter is stored in  After the neurotransmitter has performed its
the axon terminals of the presynaptic neuron. An function in the synapse, it either returns to the
electrical impulse through the neuron causes the vesicles to be stored and used again or it is
release of this neurotransmitter into the synaptic inactivated and dissolved by enzymes.
cleft.  The process of being stored for reuse is called
 The neurotransmitter then diffuses across the reuptake.
synaptic cleft and combines with receptor sites  Deficiency or an excess of a neurotransmitter
that are situated on the cell membrane of the can produce severe behavioral disorders. Some
postsynaptic neuron. major neurotransmitters and their functions are
 The cell body or dendrite of the postsynaptic given in Table 2.2.
neuron also contains a chemical inactivator that
is specific to the neurotransmitter that has been NERVOUS SYSTEM
released by the presynaptic neuron.
 When the synaptic transmission is complete, The nervous system is the master controlling, com-
the chemical inactivation quickly inactivates the municating and regulatory system in the body. Nerv-
neurotransmitter to prevent unwanted continuous ous system controls and coordinates all essential
impulses. functions of the human body. It is the center of all
mental activity including thought, learning and mem-
Neurotransmitters ory. Together with the endocrine system, the nervous
system is responsible for regulating and maintaining
 Neurotransmitters play an essential function in
homeostasis.
the role of human emotion and behavior. These
The human nervous system can be divided
are chemicals that convey information across
into two parts: the central nervous system and
synaptic cleft to neighboring target cells.
the peripheral nervous system. While the central
 They are stored in small vesicles in the axon
nervous system constitutes of the brain and the spinal
terminals of neurons.
cord, the peripheral nervous system constitutes
 When electrical impulse reaches this point, the
of the somatic system and the autonomic system
neurotransmitters are released from the vesicles.
(Figure 2.4).
 They cross the synaptic cleft and bind with
receptor sites on the cell body of dendrites
of the adjacent neuron to allow the impulse to
Central Nervous System
continue its course or to prevent the impulse Central nervous system (CNS) consists of brain
from continuing. and the spinal cord, which act as the integrating
Table 2.2: Functions of neurotransmitters
Neurotransmitter Function
Acetylcholine Regulates muscle movement and cognitive functioning

Glutamate Helps in memory process

Gamma aminobutyric acid (GABA) Moderates eating, aggression and sleeping

Regulates movements and coordination, emotions and voluntary
Dopamine decision making ability. Deficiency of dopamine causes Parkinson’s
disease, overproduction causes mental disorders like schizophrenia
Serotonin Regulates sleep, eating, mood and pain

Endorphins Reduces pain and pleasurable feelings

24 Psychology for Nurses

Figure 2.4: Schematic diagram of the relationship between parts of the nervous system

and command centers of the nervous system. They

interpret incoming sensory information and issue
instructions based on past experience and current
conditions.
Brain is composed of three main divisions: the
forebrain, midbrain and hindbrain (Figure 2.5).

Forebrain
Figure 2.5: Main divisions of the brain
Its important structures are thalamus, hypothalamus,
limbic system and the cerebrum. All sensory Limbic system consists of structures in the thala-
impulses pass through from thalamus to the higher mus, hypothalamus and cerebrum, which form a ring
centers, therefore it is usually known as the relay around the lower part of the forebrain. Major struc-
station. In addition, the thalamus has some control tures within this system include the olfactory bulb,
over the autonomic nervous system and also plays a septal nuclei, hippocampus, amygdala and cingulate
role in the control of sleep and alertness. gyrus of the cerebral cortex. The limbic system often
Hypothalamus lies below the thalamus. It exerts a called the emotional brain, functions in emotional
key influence on all kind of emotional as well as aspects of behavior related to survival, memory,
motivational behavior. Centers in the hypothalamus smell, pleasure and pain, rage and aggression, affec-
have control over the important body processes like tion, sexual desire etc.
eating, drinking, sleeping, temperature control and sex. Cerebrum is the most complex and largest part of the
It also has control over the activities of pituitary gland. brain. The cerebrum is covered by a thick layer of
 Biology of Behavior 25
tightly packed neurons called the cerebral cortex. It through the auditory nerves. It is the seat of
is divided into two hemispheres; the left and right auditory sensations and also involved in memory.
hemispheres. ™™ The parietal lobe lies in the upper rear portion of
the brain and is connected with the information
Right and Left Hemispheres, about special relationship and structure.
Association Cortex ™™ Frontal lobes contain several parts and are
concerned with organizing and planning our
Cerebral cortex is responsible for many higher order
actions, learning new tasks, generating motivation
functions like language and information processing.
and regulation of behavior (Figure 2.6 and
The cerebral cortex is divided into sensory, motor
Table 2.4).
and association areas (Table 2.3).
The cortex is divided into two hemispheres, left
™™ Sensory area receives sensory input.
and right connected by a thick layer of cells called the
™™ Motor area controls movement of muscles.
corpus callosum. Some specific differences between
™™ Association area is involved with more complex
the two hemispheres are presented in Table 2.5 and
functions such as writing.
Figure 2.7.
™™ Each cerebral hemisphere is divided into four
lobes; frontal, parietal, occipital and temporal
lobes. The different parts of the cerebrum are Association Cortex
connected with different mental functions. The Association cortex deals with more complex,
visual area lying in the occipital lobe is connected integrative functions such as memory, emotions,
with the visual organs or eye through the optic reasoning, will, judgment, personality traits and
nerve. It is the seat of visual sensations. intelligence. The association areas are:
™™ The auditory area lies in the temporal lobe and ™™ Somatosensory association areas: It permits
is connected with the auditory organs or ears to determine the exact shape and texture of an
object without looking at it.
™™ Visual association areas: It relates present to
Table 2.3: Cortical areas and its functions
past, visual experiences with recognition and
Cortical area Function evaluation of what is seen.
Primary motor cortex Initiation of voluntary ™™ Auditory association areas: It determines if a
movement sound is a speech, music or noise (Figure 2.8).
Primary Receives tactile information,
somatosensory cortex pain, pressure, position, Midbrain
movement and temperature
Midbrain is concerned with the relaying of messages
Motor association Coordination of complex
particularly those related to hearing and sight to
cortex movements
higher brain centers. One of its important structures
Speech center Speech production and
is known as reticular activating system (RAS).
(Broca’s area) articulation
Auditory cortex Auditory perception and
hearing Table 2.4: Lobes of brain and their functions

Auditory association Complex processing of Lobe Function

area auditory information Occipital Visual processing
Sensory association Processing of multisensorial Parietal Movement, orientation, calculation,
area information recognition
Visual association area Primary visual perception Temporal Sound and speech processing,
aspects of memory
Wernicke’s area Comprehension of spoken
language Frontal Thinking, conceptualization, planning
26 Psychology for Nurses

Figure 2.6: Lobes of brain

Table 2.5: Activities of right and left hemispheres

Activities Right hemisphere Left hemisphere
Specialties • Copying of designs • Language skills
• Discrimination of shapes • Skilled movements
• Reading
• Music
• Holistic processing
• Understanding metaphor
• Expressing emotions
Emotions • Negative emotions • Positive emotions
Neurotransmitters • Higher levels of norepinephrine • Higher levels of dopamine
Gray matter and white matter ratio • More white matter on right • More gray matter on the left
Shared • Sensations on both sides of the face
• Sound perceived by both ears
• Pain
• Hunger
• Position

With the help of this structure an individual is able

to decide. which impulses should be registered
consciously and, which should be rejected.

Hindbrain
Hindbrain is composed of three structures the
medulla, pons and cerebellum. ‘Medulla’ controls
breathing and many important reflexes, such as
those that help us to maintain our upright postures.
It also regulates the highly complex processes like
Figure 2.7: Left and right brains digestion, respiration and circulation. The ‘pons’
 Biology of Behavior 27
assist in breathing, transmitting impulses from organ for effective reflex actions like withdrawal of
the cerebellum to the higher brain regions and in the hand when something is hot. These reflex actions
coordinating the activities of both sides of the brain. are almost automatic in nature.
‘Cerebellum’ is responsible for body balance and
the coordination of body movements like dancing, Peripheral Nervous System
typing, playing, etc. (Figure 2.9). The nerve tissues lying outside the bony case of the
CNS come in the region of the peripheral nervous
Spinal Cord system. It consists of a network of nerves, which
Spinal cord works as a channel of communication helps in passing the sense impressions to the CNS
from and to the brain. It is a rope-like structure, made as well as in conveying the orders of the CNS to
up of long round nerve fibers. It also works as an the muscles. This peripheral nervous system is
subdivided into two parts, the somatic system and
the autonomic system.
The somatic system is both a sensory and a
motor system. The autonomic system is only a motor
system consisting of two divisions, the sympathetic
and parasympathetic system. The sympathetic
system is connected to the spinal cord and carries
messages to the muscles and glands particularly in
stress situations to prepare for an emergency. The
parasympathetic system is connected to the brain and
to the lower portion of the spinal cord. It tends to be
active when we are calm and relaxed. The messages
Figure 2.8: Localization of mental functions in the brain
conveyed by the nerve fibers of this system direct the

Figure 2.9: Major structures in the brain

28 Psychology for Nurses

organs to do just the opposite of what the sympathetic The connecting nerve fibers are known as ‘associate
system had done. It directs the body organs to return fibers’. The associate fibers are the foundations of
to the normal state after the emergency has passed. memory, language, reasoning and other higher mental
The sympathetic and parasympathetic divisions of processes. There is great coordination between the
the autonomic nervous system work in close co- various parts of the brain.
ordination for maintaining the equilibrium of the Autonomic nervous system is autonomous
body function. and works independent of voluntary control. It is
made up of nerves connecting with the glands and
Nature of Behavior of an Organism, smooth muscles, which are involved in respiration,
Integrated Responses circulation and digestion. These processes go on
automatically without our knowledge. The system
Integrative Function of the Nervous System operates actively during emotional states. When we
The various activities of the nervous system can are well, physical and mental activities are integrated.
be grouped together as three general, overlapping We receive stimuli and are able to think, learn and
functions. remember. We are able to experience the various
 Sensory types of feelings. In illness, the normal healthy
 Integrative functioning of the body and its various organs is
 Motor upset. Illness affects the threshold levels of our
Millions of sensory receptors detect changes, nervous system, may cause abnormal reactions
called stimuli, which occur inside and outside the body. to ordinary stimuli. It may adversely affect our
They monitor such things as temperature, light and coordination, may disturb our thinking processes.
sound from the external environment. Inside the body, Even the process of association is adversely
the internal environment, receptors detect variations affected, resulting in funny and stray thoughts.
in pressure, pH, carbon dioxide concentration and Specific diseases and conditions have their own
the levels of various electrolytes. All of this gathered effects, some causing permanent damage to
information is called sensory input. the nervous system and others causing only a
Sensory input is converted into electrical signals temporary damage.
called nerve impulses that are transmitted to the
brain. There the signals are brought together to create Importance of knowledge of the
sensations, to produce thoughts or to add to memory; Nervous System and Glands to a Nurse
decisions are made each moment based on sensory
™™ It helps the nurse to understand the physiological
input. This is integration.
basis of patient behavior.
Based on the sensory input and integration
™™ It helps the nurse to understand how glandular
the nervous system responds by sending signals
secretions influence personality.
to muscles, causing them to contract or to glands
™™ It helps the nurse to understand the various
causing them to produce secretions. Muscles and
glands are called effectors, because they cause an diseases of nervous system and glands and their
effect in response to detections from the nervous effect on human behavior.
system. This is the motor output or motor function.
The cerebral cortex has primary areas, which REVIEW QUESTIONS
control the incoming sensory stimuli and the outgoing
motor responses. An individual is able to adjust Long Essays
himself effectively to the environment, because the 1. Explain about the physiological basis of behavior.
various nerve impulses are systematically integrated (Apr 2006)
by the brain. There are millions of nerve fibers, 2. Discuss endocrine system and its influence on
which connect the various neurons of the brain. development of behavior. (Mar 2009)
 Biology of Behavior 29
Short Essays 3. Integrated responses. (Oct 2007)
1. Importance of environment in behavior change. 4. Heredity. (Mar 2011, May 2007, Nov 2003)
(Mar 2012) 5. Chromosomes. (Oct 2006)
2. Write a short note on sense organ. (Apr 2006) 6. Environment. (Apr 2006)
3. What is the role of heredity and environment in 7. Identical and fraternal twins. (Apr 2006)
shaping behavior? (April 2005, 2004, Nov 2003) 8. List of endocrine glands. (Apr 2006)
4. Genetics and behavior. (Mar 2011) 9. Name any four endocrine glands. (2004,Nov 2003)
5. Heredity and environment (Mar 2012, Mar 2009) 10. What are ‘endocrine glands’? (2004)
11. Principles of heredity. (Sep 2011)
12. Glands. (Aug 2010)
Short Answers 13. Parts of neuron. (Mar 2009)
1. Principles of heredity. (Oct 2007) 14. Levels of consciousness. (Mar 2009)
2. Genes. (May 2007) 15. Meiosis. (Sep 2009)
 CHAPTER

Cognitive
Processes 3
ATTENTION exercise his will power, attend to the assigned task
and finish it properly.
Attention is the focus of consciousness on a particular
object or idea at a particular time, to the exclusion of Explicit volitional attention: Attention is obtained
other objects or ideas. by repeated acts of will. One has to struggle hard
for keeping oneself attentive; it requires a strong
Definitions will power, keen attention and strong motives
for accomplishment of the task. For example, the
Attention is defined as a process, which compels
attention paid during examination days for securing
the individual to select some particular stimulus
good grades.
according to his interest and attitude out of the
multiplicity of stimuli present in the environment.
Involuntary Attention
(Sharma RN–1967)
Attention is the concentration of conscious­ness upon This type of attention is aroused without the play of
one object rather than upon another. will or without making a conscious effort on our part.
(Dumville–1938) For example, we give involuntary attention to loud
sounds, bright lights and strong odors, etc.
™™ Involuntary or non-volitional attention aroused
Types of Attention
by the instincts is called enforced non-volitional
™™ Voluntary (volitional) attention. For example, giving attention out of
™™ Involuntary (non-volitional) curiosity.
™™ Non-volitional attention aroused by sentiments
Voluntary Attention is called spontaneous non-voli­ tional attention.
Voluntary attention demands a conscious effort For example, we give some­what automatic or
on our part. For example, solving an assigned spontaneous attention towards some objects,
problem in Mathe­matics, answering a question in an idea, person, around which our sentiments are
examination needs voluntary attention. It is further formed.
subdivided into two categories:
™™ Implicit volitional attention Determinants of Attention (or) Methods
™™ Explicit volitional attention of Arousing Attention (or) Factors and
Implicit volitional attention: A single act of will is Conditions Favorable for Capturing
responsible for arousing attention. For example, a Attention
teacher assigns practice work to a child and warns Certain factors produce and control the condition
of punishment, if not completed. This can make him of attention in a person. These factors are classified
 Cognitive Processes 31
as, external (objective)–those found in one’s that advertisements given on the front page or on the
environment and internal (subjective)–those within upper half of any page attract more attention.
the person himself. The methods of securing
Repetition of the stimulus: A repeated stimulus
attention are, based upon these external and internal
attracts our attention. We may ignore a stimulus at
factors of attention.
first instance but, when it is repeated several times,
it captures our attention. A mis-spelt word is more
External Factors or Conditions
likely to be noticed, if it occurs twice in the same
Nature of the stimulus: All types of stimuli are not paragraph than if it occurs only once. But this
able to evoke the same degree of attention. An practice of repetition should be carefully used. Too
attractive stimulus should always be chosen for much repetition of a stimulus may bring diminishing
capturing maximum attention. A picture attracts returns.
attention more readily than words. Among the
Movement of the stimulus: A moving stimulus catches
pictures, the pictures of human being (especially
our attention more quickly than a stimulus that does
beautiful woman or handsome men) capture more
not move. This is why the pictures on a television
attention than those of animals or objects. It has been
screen or those in a cinema hold our attention for
found that in comparison with other sensations, color
hours at time.
and sound attract more attention.
Definite form of the object: A sharply defined object
Intensity of the stimulus: In comparison to a weak
attracts our attention more than a broad indefinite
stimulus, an intense stimulus attracts more attention of
object. A figure attracts more attention than the
an individual. Our attention becomes easily directed
background. A very clearly defined object attracts
to a loud sound, a bright light or a strong smell.
our attention more than a vaguely indefinite object.
Size of the stimulus: As a general rule bigger size
Isolation of the stimulus: Isolation is an important
objects in the environment are more likely to catch
external determinant of attention. A student sitting
our attention than a small object. A small size on a
alone in the corner of the class is seen first (attracts
very big background also attracts attention.
more attention than others).
Contrast, change and novelty: Change and variety
strike attention more easily than routine. The use Internal Factors or Conditions
of maps and charts suddenly attracts the student’s A person’s attention to a stimulus depends not
attention, when compared to the routine verbal talk. only upon the characteristics of the stimulus or the
We do not notice the ticking on the watch but it favorable environmental conditions but also upon his
arrests our attention, as soon as it stops. interest, motives, basic needs and urges, etc.
Any change in the stimulation to which we have
become adapted immediately captures our attention. Interest and attention: Interest is a very helpful
Novelty means something new or different. It factor in securing attention. We attend to objects, in
attracts attention very easily and is closely related which we are interested than those in which we are
to change. A new building, a new teacher are all not interested.
examples of common novelty. So it is always
Motives: The basic drives and urges of the individ-
better to introduce a change or novelty for breaking
ual are very important in securing attention. Thirst,
monotony and securing attention.
hunger, sex, curiosity, fear are some of the important
Location of the stimulus: The location of the stimulus motives that exercise definite influence upon atten-
also affects attention. In the case of visual stimuli, tion. When hungry we may attend to even distasteful
the most effective location is to be just in front of the food but while our belly is full we may not attend to
eyes. For example, it has been found in experiments even the tastiest one.
32 Psychology for Nurses

Mental set-up: A person always attends to those time of exposure is very short, ranging from 1/100
objects, towards which his mind has set. For to 1/5 of a second. The objects exposed to the eye
example, on the day of examination the slightest are simple like dots, lines, letters or complex words
thing concerning the examination easily attracts the or triangles, etc. The mind can attend to only four or
attention of the students. five separate units if the items are not grouped into
familiar units. But if the items are combined into
Past experience: Learning and previous experience
meaningful wholes, for instance, letters are arranged
facilitate attention. If we know by our past experience
into words, a large number of items can be perceived
that a particular person is sincere to us, we pay atten­
at once.
tion to what ever he advices.
Span of auditory attention: The number of auditory
Emotion: The emotional state, in which a person
impressions perceived at a single instance is slightly
deter­mines attention. For example, a person attends
greater. An adult can perceive eight sounds given
only to bad qualities of his enemy.
rapidly in succession. But when sounds are given in
Habit: Habit is also an important determinant of a rhythm, a much larger number of sounds can be
attention. A man develops the habit of attending to perceived.
necessary and desirable things and on the other hand
also develops habit of not attending to unnecessary Duration of Attention
and undesirable things. It refers to, how long one can attend to an object
Aim: Every man has some immediate and ultimate without a break. If we attend to a single, simple
aims. So a student whose aim is to pass the object for instance, a dot, it will remain in the focus
examination will at once attend to the textbooks or of our consciousness for only a second at the most,
notes. then something in the margin will crowd it out or
memory of a past event will intrude.
Meaning: In comparison to meaningless stimuli, The duration of attention depends upon the
meaningful stimulus attracts more attention. nature of the material, the interest of the observer,
Disposition (natural tendency) and temperament: Both and other conditions.
are important internal factors which attract attention.
For example, a man having a religious disposition Sustained Attention (Act of Fixation of Mind)
and spiritual temperament will attend to religious To sustain attention, is to concentrate one’s activity
matters. continuously upon some object or a happening or a
Besides the conditions described above many problem. The individual attention always remains
other factors influence attention, such as heredity, on track and the activity proceeds systematically
education, family, school, society, training etc. which without any serious distraction. All internal as well
have a wide influence on attention. as external factors of getting attention can be helpful
in this track.
Duration and Degree of Attention
Shifting Attention
Span of Attention
While paying attention towards an object or an event,
The maximum amount of material that can be it is not possible to hold attention conti­ nuously
attended in one period of attention is called span of with the same intensity for a longer duration. It is
attention. This can be visual attention or audi­tory constantly shifting from one object to another,
attention. from one aspect of the situation to another. We can
Span of visual attention: Experiments have been perform only one voluntary act at a time and not two
carried out to measure the span of visual attention by or more acts at a time. However, we can quickly shift
making brief exposures to a number of objects. The attention from one voluntary act to another.
 Cognitive Processes 33
Division of Attention Types of Distraction
Division of attention means to attend to two or more
tasks simultaneously. Psychologists say we cannot Continuous Distraction
attend to two things at a given time and there is no The distraction is continuous in nature. For example,
possibility of division of attention. the sound of radio played continuously, the noise at
The reason for paying attention to more than one the market place, etc. Experiments have shown that
task at a given time can be: adjustment to continuous distraction takes place
™™ In performing two tasks simultaneously one of
quickly.
the two activities requires no attention.
™™ Attention rapidly shifts from one task to the other.
Discontinuous Distraction
It is irregular. For example, the hearing of somebody’s
ALTERATIONS IN ATTENTION voice every now and then. It interferes with work
(DISTRACTION) because of the impossibility of adjustment.
Some major means of removing distractions are:
Distraction means any stimulus whose presence ™™ Being active in work
interferes with the process of attention or draws away ™™ Disregard for distraction
attention from the object which we wish to attend. ™™ Making the distraction a part of the work
(HR Bhatia—1968)
These alterations in attention reduce the efficien-
cy of work. PERCEPTION
When our sense organs come in contact with the
Sources of Distraction world and are stimulated by external stimuli and
The sources of distraction vary very much. They receive sensations, it results in perception. Sensation
affect the individual according to his own mental set- precedes perception. Sensation is the initial response
up and personality characteristics. The conditions of an individual to a stimulus. Perception is the
which cause distraction to an indivi­dual may prove interpretation of sensory stimuli, which reaches
helpful in sustaining attention to others. the sense organs and the brain. Interpretation gives
™™ External factors/environmental factors meaning to sensation and we become aware of
™™ Internal factors objects.

External Factors Definitions

Noise, music, improper lighting, uncomfortable seats, Perception is the experience of objects, events or
unfavorable temperature, inadequate ventilation, relationships obtained by extracting information
defective methods of teaching, defective voice of the from and interpreting sensations.
teacher, etc.
(JH Jackson, O Desiderato and
Internal Factors DB Howieson—1976)
Emotional disturbances, ill health, boredom, lack of Perception is an individual’s awareness aspect of
motivation, fatigue, etc. behavior, for it is the way each person processes
The nurse should take great care to get away all the raw data he receives from the environment, into
possible causes of distractions in working area so as meaningful patterns.
to sustain attention.  (RE Silverman—1976)
34 Psychology for Nurses

Principles of Perception (Perceptual picture either the black faces or the white vase may
Organization) become the figure. Moreover, it is impossible to
Individuals tend to organize environmental stimuli perceive both figure and background at the same time
into some meaningful patterns or whole according to (Figure 3.1).
certain principles. Some of the important principles
are: Principle of Closure
According to principle of closure, while confronting
Principle of Figure-Ground Relationship an incomplete pattern one tends to complete or close
According to principle of figure-ground relationship, the pattern or fill in sensory gaps and perceive it as
a figure is perceived in relationship to its background. a meaningful whole. This type of organization is
The perception of the object or figure in terms of extremely helpful in making valuable inter­pretation
color, size, shape and intensity, etc. depends upon of various incomplete objects, patterns or stimuli
the figure-ground relationship. We perceive a figure present in our environment. For example, the lines in
against a background or background against a figure the figure may be well percieved as letters W, M and
depending upon the characteristics of the perceiver D (Figure 3.2).
as well as the relative strength of the figure or
ground. A proper figure-ground relation­ship is quite Principle of Grouping
important from the angle of per­ception of the figure Principle of grouping refers to a tendency to perceive
or the ground. In case, where such relationship does stimuli in some organized meaningful patterns by
not exist we may witness ambiguity in terms of clear grouping them on some solid basis like similarity,
perception. proximity and continuity.
Sensory experiences other than visual experi­ On the basis of similarity, objects or stimuli
en­ces may also be perceived as figure and ground. which look alike are usually perceived as a unit.
Sometimes, when there are various parts within the For example, in the following figure vertical
general field of awareness, having equally balanced rows of black dots and blank dots may be seen to
qualities, there could be a conflict and two or more form separate groups in terms of their perception
figures may be formed. In such a case there will be (Figure 3.3).
a shifting of the ground and the figure. One part On proximity basis objects or stimuli, which
may be the ground at one moment and at the next appear close to one another are likely to be perceived
moment the ground may become the figure. In this as belonging to the same group.
Example: We see three sets of two lines each and not
six separate lines (Figure 3.4):
™™ The objects or stimuli are perceived as a unit
or group on the basis of their continuity. Our
attention is being held more by a continuous
pattern rather than discontinuous ones.

Figure 3.1: Figure-ground relationship Figure 3.2: Principle of closure

 Cognitive Processes 35
Example: We see a curved line and a straight line. Principle of Context
We do not see a straight line with small semi-circles
Perceptual organization is also governed by the
above and below (Figure 3.5).
principle of context, i.e. an examiner may award
higher marks to the same answer book in a pleasant
Principle of Simplicity
context than in an unpleasant one.
We perceive the simplest possible pattern because
they enable the perceiver to perceive the whole from Principle of Contrast
some of its parts.
Perceptual organization is very much affected
Principle of Contour through contrast effects as the stimuli that are in sharp
contrast to nearby stimuli may draw our maximum
A contour is said to be a boundary between a figure
attention and carry different perceptual affects.
and its ground. The degree of the quality of this
contour separating the figure from the ground is Example: Here the surrounding circles in A make
responsible for enabling us to organize stimuli or the central circle seem larger than the central circle
objects into meaningful patterns. in B, even though the two are of the same size
(Figure 3.6).

Principle of Adaptability
The perceptual organization for some stimuli
depends upon the adaptability of the perceiver to
perceive similar stimuli. An individual who adapts
himself to work before an intense bright light will
perceive normal sunlight as quite dim.

Factors Affecting Perception

Sense Organs
Figure 3.3
Perception depends upon the sense organs or
receptors, on which the stimuli act and sensory
neurons, which transmit the nerve current from
the receptors to the sensory area of the brain. For
example, if cones are not developed in the retina,
color cannot be perceived.

Figure 3.4

Figure 3.5
Figures 3.3 to 3.5: Principle of grouping Figure 3.6: Principle of contrast
36 Psychology for Nurses

Brain certain circumstances leading to impaired percep-

Perception depends upon the functioning capa­city of tions, these are: illusions and hallucinations.
sensory area and the association areas of the brain.
For example, if the auditory area is destroyed we Illusion
cannot have auditory perception. Illusion is a misinterpretation of actual perception.
When the interpretation of a particular stimulus goes
Memory Images of the Past Experience wrong, it gives rise to a wrong perception or illusion.
Memory images help us in the comprehension of the For example, a rope in the dark is per­ceived as a
object or stimulus before us. Generally, perception snake.
involves the integration of sensory experience in the Illusions are caused by inadequacies of our
light of past experience and present psychological sense organs, distance of the object from the sense-
conditions. Experiments have shown that whenever organ which perceives it, misleading stimuli in the
we come in contact with new stimuli we are inclined environment, our perceived notions and expectancy.
to interpret them in terms of our experiences with
similar stimuli in the past. For example, a child has Hallucination
come in contact with a horse for the first time. He has Hallucination is identified as one of the major errors
already seen a cow. When he is asked what it (horse) of perception. These are sensory perceptions, in
is, he may say it is a cow or like a cow. the absence of any corresponding external sensory
stimuli. Hallucinations are imaginary perceptions, in
Personal Interests and Mind Set which one sees or hears something that is not seen
We perceive those things quickly and clearly, which or heard by others around him. An alcoholic may
are concerned with our interests and mind set. see “pink elephants”, a para­noid schizophrenic may
hear voices, expe­rience foul odors in the absence of
Acquired Interests any sensory stimu­lation. Hallucinations are more
common in mentally ill people.
Our acquired interests also determine the object or
Depending upon the particular sensory moda­lity
objects, which we perceive. A person, who has a
people experience different types of hallu­cinations,
hobby of collecting stamps will quickly notice any
for example, visual, auditory, kines­thetic, olfactory
new stamp on a letter.
and gestatory.
Accurate perception is absolutely necessary in
Needs and Desires
order to record an accurate observation. It is possible
Our needs or desires also modify our perceptions. to make errors in perception due to a number of
Besides these, our beliefs, opinions and cultural reasons.
ideals also modify our perception of things, situations
and objects. Causes for Inaccurate Perception
In addition to the above functional factors the  Defective functioning of sense organs: For
structural factors, which affect perception are nature example, myopia, deafness, anesthesia or other
of physical stimuli and their arrangements and the sensory defects can cause inaccurate perception.
neural effects they evoke in the nervous system of  Inadequate stimulus: Our receptors may not be
the individual. stimulated adequately, if stimuli were not strong
enough, vague or indefinite. A very weak light
Errors in Perception or soft sound will make it difficult to perceive
Perceptual processes enable an individual to perceive correctly.
things accurately and facilitate smooth functioning.  Too many stimuli at one time: When too many
However, some errors creep into this process under stimuli are present at one given time, per­ceiving
 Cognitive Processes 37
one stimulus correctly is difficult. For example, Nature of Learning
in the presence of loud noises, it may be difficult  Learning is a process and not a product.
to perceive the call of a patient.  It involves all those experiences and trainings of
 Poor health: Sense organs cannot function an individual (right from his birth), which helps
adequately and correctly as a result of illness. For
him to produce change in his behavior.
this reason, the perceptions of patients may be
 Learning brings changes in the behavior but it
inaccurate.
does not necessarily mean these changes always
 Limited attention: If we try to apprehend more
bring improvement or development in the
things than we can at a time, we are liable to have
positive direction. One has equal chances to drift
an inaccurate perception.
to the debit side of human personality.
 Figure merges in the ground: Sometimes objects
are perceived with difficulty because they  Learning prepares an individual for the necessary
resemble their surroundings. For example, a adjustment and adaptation.
white patch is difficult to detect on a white wall.  All learning is purposeful and goal-oriented. In
The nurse learns to perceive sign of illness or case there is no purpose, there would hardly be
wellness in patients only, when she learns what any learning.
these signs are.  The scope of learning is too wide to explain in
 Guidance: Perception is inaccurate, when we do words. It is a very comprehensive process, which
not know what should be perceived. covers nearly all the domains-conative, cognitive
and affective of human behavior.
LEARNING  Learning is universal and continuous. Every
creature that lives learns. In human beings it is
One of the most important characteristics of human not limited to any age, sex, race or culture. It is a
beings is their capacity to learn. An indi­ vidual continuous never-ending process that goes from
starts learning immediately after his birth or in a womb-to-tomb.
strict sense even earlier in the womb of the mother.  Learning does not include the changes in behav-
Our personality–our habits, skills, knowledge, ior on account of maturation, fatigue, illness or
attitudes, interests and character is largely the result drugs, etc.
of learning. It is the key process in human behavior.  Learning is transferable from one situation to
All our adaptive as well as maladaptive, our another.
cognitive as well as affective behavior are formed  Learning helps in the proper growth and devel-
by learning processes. These are of vital importance opment.
in helping the individual to adapt to his changing ⓫ Learning helps in the balanced development of
environment.
personality.
Definitions
Types of Learning
Learning is the acquisition of habits, knowledge and
attitudes. It involves new ways of doing things and Stimulus Response Learning
it operates on an individual’s attempts to overcome Conditioning learning involves the conditioning of
obstacles or to adjust to new situations. It represents respondent behavior through a process of stimulus
progressive changes in behavior. It enables him to association and substitution. In this learning estab-
satisfy interests to attain a goal. lishment of connections between sensory systems
(Crow and Crow—1973) and motor systems will occur.
The term learning covers every modification in  Classical conditioning: Association between two
behavior to meet environmental requirements. stimuli viz. unconditioned stimulus (US), and
(Gardner Murphy—1968) conditioned stimulus (CS).
38 Psychology for Nurses

 Instrumental conditioning: Association between Motor Learning

a response and a stimulus; allows an organism to When learning involves primarily the use of muscles,
adjust its behavior according to the consequences it is called motor learning. In this type the individual
of that behavior. For example, reinforcement acquires new muscular coordina­tions as a mode of
(positive, negative) and punishment. response to a similar situation. Learning to walk,
swim, play throw ball, piano are examples of motor
Perception Learning learning.
Sight, hearing, taste, smell and touch are considered
as the five gateways of knowledge. All knowledge is Concept Learning
based on sense perception. The individual receives A concept is the form of a mental image that denotes
information from sense organs and interprets them a generalized idea about things, persons or events.
in the light of previous experience. The attaching In learning a concept, an indivi­dual tries to find out
of meaning to sensation is called perception. This some common property in a group of objects. This
perception is the foundation of all higher forms of learning implies that the individual starts thinking
learning and since it depends on sensations, the in abstract terms. He understands about the object
first physio­logical factor, which is involved in the without its concrete form. These abstract concepts
learning process is sensation. Learning is dependent gradually multiply and become a part of the mental
on the relative perception of the senses. This learning makeup.
is confined to the presentation of the concrete object For example, our concept of ‘car’ is a mental
(Figure 3.7). image that throws up the simi­larities or common
properties of all the different cars we know. We
Verbal Learning will call a thing ‘car’ when it has some specific
All learning taking place in formal education is characteristics, the image of which we have already
verbal learning. Learning of this type helps in the acquired in our mind on account of our previous
acquisition of verbal behavior. The language we experience, perception or exercise of imagination.
speak, communication devices we use are the result The forma­ tion of such concepts on account of
of such learning. Signs, pictures, symbols, words, previous experience, training is called concept
figures, sounds and voices employed by individual learning. Concept learning proves very useful in
are the essential instruments in the process of verbal recog­nizing, naming and identifying things. Once
learning. a concept is formed, an individual manipulates it in
language and thinking.

Problem Solving Learning

Problem solving learning is a higher type of learning.
This learning requires the use of cognitive abilities like
thinking, reasoning, generalization, imagination, etc.

Attitude Learning
Much of our learning is based on attitudes. Because
of formation of attitudes we show favorable or
unfavorable responses to various objects, persons or
situations. The individual learns a subject based on
Figure 3.7: Types of perceptual learning his attitude towards the subject.
 Cognitive Processes 39
Paired-associate Learning The cognitive faculties of the learner include his
In paired-associate learning, learning tasks are or her five senses, memory, imagination, as well as
presented in such a way that they may be learned the intellect. All of these faculties are related to the
by reason of their associations. Krishna, a boy’s basic operation of the human brain and are necessary
name may become easy to remember in a paired for the learning process.
association with Lord Krishna. Much of the verbal  Through the five senses, the learners are able to
or motor learning may be acquired by means of the see, hear, taste and smell. He or she can grasp
technique of paired or multiple association. different information from his or her surrounding
environment using these natural senses.
Other Types of Learning  With the learner’s imagination, he or she can
form pictorial representation of material objects
Visual learning, auditory learning, kinesthetic and
in his or her mind. This ability is an important
tactile learning (Figure 3.8).
factor in the learning process.
These types do not always occur inde­pen­dently.
 The learner’s memory is one of the important
Two or more of the above types of lear­ning are
factors in learning. With the use of the memory,
involved in many situations, for example, in typing
the learner can recall or retain post mental actions
both motor and verbal learning are involved. In
in his or her mind. The memory serves as storage
playing chess problem solving, concept learning and
for the prior knowledge of the learner.
verbal learning are involved.
 The learner’s intellect is also an important factor
in learning. With the use of the learner’s intellect,
Learner and Learning
he or she can form concepts of ideas, as well as
There are certain fundamental qualities of a learner make judgment from the given information and
that can be considered as the learner’s equipment reason out.
in order for him or her to absorb the knowledge in The appetitive faculty of the learner that can also
learning. These fundamental equipments are the be considered as an equipment in learning includes
learners cognitive as well as the learner’s appetitive the feeling, the emotion as well as the learner’s
faculties. These faculties will naturally help or guide rational will.
the learner as he dealt with the learning process.  Using the learner’s feelings as well as his or her
emotions, he or she can experience pain or joy, as
well as the feelings of being happy, sad or angry
towards a particular subject or situation.
 With his or her feelings, he can identify and
experience the real feelings about a particular
thing or situation.
 Using the learner’s rational will, he or she has the
capacity to think and choose, what is desirable
according to his or her own analysis. His or her
rational will, will serve as a kind of guiding force
or a main integrating force in his or her character.

Factors Influencing Learning

Learning is a process of bringing relatively permanent
change in behavior of the learner through experience
or practice.
The learning process is centered on three ele-
Figure 3.8: Types of learning ments:
40 Psychology for Nurses

 The learner, whose behavior is to be changed or results in learning. If the learner has a will to learn a
modified. thing, he finds a way for effective learning.
 The type of experience or training required for Maturation: Maturation helps in the process of
modification in the learner’s behavior. learning. We learn things, when we are mature to learn
 The men and material resources needed for them. Maturation and learning are closely related to
providing desired experiences and training. each other. Learning can only take place if the stage
The success or failure in the task of learning for that type of learning has been achieved through a
depends upon the quality as well as control and process of maturation. For example, the child has to be
management of the factors associated with the above physically mature before he can learn to walk or run.
elements.
Age: Age is also an important factor in learning.
Factors Associated with Learner There are certain limitations that old people face
Learner’s physical health: Physical health of the in learning new things. They are physically weak
learner is an important factor. Fever, sensory defects and their ability to learn is slow. They have a poor
particularly of the eyes or the ears, malnutrition, recent memory and their reasoning speed decreases.
loss of sleep and fatigue are some of the physical Learning ability for verbal material increases till age
handicaps that hinder effective learning. The learner twenty. After that there is a slow decline till the age
should have sound health for learning. of fifty followed by a sharp drop in the later years.

Learner’s mental health: Experiments have shown Emotions: Tension or anxiety is a double-edged
that worries, fears, persistent day dreams; feelings emotion. It has a positive as well as a negative effect
of loneliness and inferiority affect learning. If the on learning. Some amount of stress or anxiety is
learner has no self-confidence, self-reliance or self- essential for learning. It provides the drive to learn.
respect due to the attitudes of teachers or others, Our learning improves with moderate amount of
it is very difficult for him or her to learn well. stress. But after a certain optimal level, learning
Hence, the necessity of building up the learner’s efficiency declines with further increase in stress.
self-confidence, self-respect, self-reliance through Sex: Although no sex is superior to the other, certain
praise and approval for the work well done or well differences in interests and aptitudes are found
attempted is essential. between the two sexes. Females like to learn things
that involve people, while men are more object-
Basic potential of the learner:
oriented.
™™ Learner’s innate abilities and capacities for
learning.
Factors Associated with Type of Learning
™™ Learner’s general intelligence, knowledge, un-
Experience
derstanding skills, etc.
™™ Learner’s basic interest, aptitudes and atti­tudes Nature of learning experience: Learning is influenced
related to the learning of a particular thing or area. by the nature of the subject matter and the learning
experiences presented to a learner, such as formal
The level of motivation: The stronger and clearer the
or informal, incidental or well planned, direct or
motive in learning anything, the greater is the effort
indirect.
and interest shown by the learner in learning it. The
result is greater and more permanent learning. Methodology of learning: Learning depends upon the
methods, techniques and approaches employed for the
Goals of life: The philosophy of immediate as well
teaching and learning of the selected contents. Some
as ultimate goals of one’s life affects the process and
of these techniques are:
product of learning.
™™ Linking the recent learning with those of the past.
Readiness and willpower: A learner’s readiness and ™™ Correlating learning in one area with that of
willpower to learn is a great deciding factor of his another.
 Cognitive Processes 41
™™ Utilization of maximum number of senses. not quick for action, the response does not follow
™™ Revision and practice. readily. Learner’s reaction depends upon the readi-
™™ Provision of proper feedback and rein­force­ment. ness of the sensory and motor neurons.
Meaningfulness of material: The more meaningful
the material, the faster it is learned. Law of Effect
A successful reaction gives satisfaction to the
Amount or length of material: Learning is influenced individual and the same reaction tends to be repeated.
considerably by the amount and length of the An unsuccessful reaction gives anno­ yance to the
material to be learned. In general, more the amount individual and tends to be inhibited. Thus, pleasure
of material to be learned, more the time the person and pain have their effects on learning reactions.
will take to learn it.
Law of Exercise/Use
Factors Associated with Men and Material
Native reactions are strengthened by practice. The
A learner is helped by the available resources for
use of any response strengthens it and makes it more
bringing desirable changes in his behavior. Certain
prompt, easy and certain.
factors which affect learning are:
™™ Quality of teaching.
™™ Availability of appropriate learning material and
Law of Frequency
facilities like teaching-learning aids, textbooks, The law of frequency is correlated to law of use.
library and laboratory facilities, project works, If one response strengthens the situation-response
etc. connection, two responses will strengthen it further,
™™ Availability of conducive environment like, three still further and so on. The more frequently a
proper seating arrangement, calm and peace­ful connection is exercised, the stronger the connection
environment, absence of distractions, cooperative becomes.
and competitive group situations, congenial
learning environment at home, provision of Law of Disuse
opportunity for creativity and self-expression. Any learning process, which is not practiced for
sometime gradually decays. Use strengthens a situ-
LAWS OF LEARNING ation-response connection. Disuse weakens the con-
nection. Material without any meaning like nonsense
The various laws of learning are as under:
syllables is quickly forgotten. The material with a
™™ Law of readiness
meaning like poetry is not so quickly forgotten.
™™ Law of effect
™™ Law of exercise/use
™™ Law of frequency
Law of Recency
™™ Law of disuse The law of recency is correlated to law of disuse.
™™ Law of recency The more recent is the exercise, the stronger is the
™™ Law of primacy connection between the situation and the response.
™™ Law of purpose The connection between a situation and the response
™™ Law of association is weakened gradually through disuse.

Law of Readiness Law of Primacy

Learning takes place best, when a person is ready to The first experiences and acts are novel and apt to
learn. Some sort of preparatory attitude or a mindset attract attention. They are readily impressed in the
is necessary. If nervous pathway is ready for action, mind. The first day at school, the first act in learning
the response quickly follows. If it is exhausted and to solve a puzzle are easily impressed.
42 Psychology for Nurses

Law of Purpose the cat to come out of the box. Consequently, the cat
With a clear or definite goal in mind, the student made a number of random movements such as biting,
works towards a definite purpose. clawing and scrambling around, as it struggled to
come out the box. In one of the random movements,
by chance, it manipulated the latch. The door then
Law of Association
opened and the cat came out and got its reward.
It is on the basis of association of ideas that we can For another trial, the process was repeated.
explain, why one idea gives way to the other and so But this time, it took less time in coming out. On
on. When we recall the name, we at once remember subsequent trials, such incorrect responses like
about its association, for example, when we say Taj biting and clawing gradually diminished, until
Mahal, we recall it is made of marble because these the cat reached a stage, when it manipulated the
ideas are closely associated with one another. The latch as soon as it was put in the box and came out
laws which govern the asso­ciation of ideas are as immediately to eat the fish. In this way gradually, the
follows: cat learned the art of opening the door. Thorndike
™™ The law of similarity named the learning of his experimental cat as ‘trial
™™ The law of contrast and error learning’ (Figure 3.10). He maintained
that learning is nothing but the stamping in of the
THEORIES OF LEARNING correct responses and stamping out of the incorrect
responses through trial and error. In trying for the
Trial and Error Theory of Learning correct solution the cat made many vain attempts,
committed error after error before gaining success on
subsequent trials, tried to avoid the erroneous ways
and repeated correct way of manipulating the latch.
™™ From the above experiments, Thorndike said
that the following components or elements are
involved in the process of learning.
−− Drive
−− Goal
−− Barrier or blocks which prevent the indi­
vidual reaching the goal
−− Random attempts to overcome the barriers
Figure 3.9: Edward Lee Thorndike −− Chance success
This theory was propagated by Edward Lee −− Selection of the correct response
Thorndike (1874-1949). According to Thorndike −− Fixation of the correct response in the
(Figure 3.9), learning consists of making bonds or neuromuscular system of the individual
connections between stimuli and responses. These ™™ Major theoretical principles which form the basis
bonds are made in the nervous system. According of Thorndike theory of learning are:
to Thorndike, learning is nothing but the stamping −− Learning involves trial and error or selection
in of the correct responses and stamping out of and connection.
the incorrect responses through trial and error. To −− Learning is the result of the formation of
support his point of view, the following is one of the connections.
experiments conducted by Thorndike: −− Learning is improvement in performance not
A hungry cat was placed in a box. There was insightful.
only one door for exit, which could be opened by −− Learning is direct, not mediated by ideas.
correctly manipulating a latch. A fish was placed ™™ Based on his theory, Thorndike put forward the
outside the box, which worked as a strong motive for following laws of learning:
 Cognitive Processes 43

Figure 3.10: Edward Lee Thorndike devised this puzzle box to study trial and error learning

−− The law of readiness as relevant, to make learning effective (law of

−− The law of effect of satisfaction/dissatisfac- effect).
tion  The learner should try to see the similarities
−− The law of exercise or practice and dissimilarities between the different kinds
−− The law of multiple responses or varied of responses to stimuli and by comparison and
reactions contrast try to apply the learning from one
−− The law of attitude situation to other similar situations.
−− The law of analogy  The learner should be encouraged to perform his
−− The law of associative shifting task independently. He must try various solutions
to the problem before arriving at the correct one.
Educational Implications of Thorndike Theory In general, Thorndike theory and laws of learning
 According to Thorndike, when a child is ready contributed towards making learning purposeful and
to learn, he learns more quickly and effectively. goal oriented and has brought out the importance of
He warns that the child should not be forced to motivation, rewards and practice in the process of
learn when he is not ready and also not to miss teaching and learning.
any opportunity of providing the right learning
experiences, when the child is prepared to learn. Learning by Conditioning
The task of the teacher is to motivate the students
by arousing their attention, interest and curiosity,
so that they want to learn (law of readiness).
 The teacher must try to strengthen the bonds
or connections between stimuli and responses,
through repetition, drill and practice. Other­
wise, the bonds get weakened through disuse and
learning fails to occur (law of practice).
 The child must be provided with learning
experience, which gives him a sense of satis­ Figure 3.11: Ivan pavlov
faction. The child must be suitably rewarded Propounded the classical theory of learning
44 Psychology for Nurses

Theory of classical conditioning (or) type-S period during extinction, it will once again salivate
conditioning or respondent learning. when the bell is rung. This phenomenon is called as
The theory of classical conditioning was spontaneous recovery.
proposed by Ivan Pavlov (1849-1936), a Russian  Prior to conditioning, the ringing of a bell does
physiologist (Figure 3.11). Pavlov, while studying not bring about salivation – making the bell
the physiology of digestion; found that behavior a neutral stimulus. On the other hand, food
can be classically conditioned. He experimented naturally brings about salivation, making the
on a dog and found that food placed in the mouth food an unconditioned stimulus and salivation an
of a hungry dog automatically causes salivation. unconditioned response (Figures 3.12A and B).
In this case, salivation is an unlearned response,  During conditioning, the bell is rung just before
or an unconditioned response and the food is an the presentation of the food (Figure 3.12C).
unconditioned stimulus (natural). Later on, a bell  After conditioning, the ringing of the bell alone
was rung each time before the food was presented. brings about salivation. The bell which was earlier
Pavlov now found that the dog started to salivate considered as neutral stimulus is now considered
at the sound of the bell and this was termed as a as conditional stimulus bringing about conditioned
conditioned response. The bell is a conditioned response of salivation (Figure 3.12D).
stimulus (artificial stimulus).
In later studies Pavlov noticed that if he did
Classical Conditioning
not provide food after the bell was rung, the dog
eventually stopped salivating called ‘extinction’ and A type of learning, in which a neutral stimulus
demonstrated that reinforce­ment is essential both to comes to bring about a response after it is paired
acquire and maintain respondent learning. Pavlov with a stimulus that naturally brings about that
also found that if the dog is given a prolonged rest response.

A B

C D
Figures 3.12 A to D: The basic process of classical conditioning: A and B. Before conditioning,
C. During conditioning, D. After conditioning
 Cognitive Processes 45
Neutral Stimulus are brought together several times, the dog becomes
A stimulus that, before conditioning, does not condi­tioned to respond to this situation as perfect
naturally bring about the response of interest. association occurs between the types of stimuli
presented together. As a result, after some time, the
Unconditioned Stimulus natural stimulus can be substituted or replaced by an
artificial stimulus and this artificial stimulus is able
A response that is natural and needs no training
to evoke the natural response.
(Example, salivation at the smell of food).
Educational Implications of Classical
Conditioned Stimulus
Conditioning Theory
A neutral stimulus that has been paired with an
 Fear, love or hatred towards a particular subject
unconditioned stimulus (UCS) to bring about a
is created through conditioning. A teacher, with
response earlier caused only by the UCS.
his defective methods of teaching or harsh
Conditioned Response treatment of his students, may create a strong
dislike among them towards the subject.
A response that, after conditioning, follows a
 On the other hand, interesting and effective
previously, neutral stimulus (Example, salivation at
methodology in teaching along with sym­pathetic
the ringing of a bell).
treatment can have a desirable impact on the
Extinction students through the process of condi­ tioning.
They develop a positive attitude towards the
The decrease in frequency and eventual dis­
subject as well as the teacher, who has imparted
appearance, of a previously conditioned response;
the knowledge to them.
one of the basic phenomena of learning.
 The theory of classical conditioning empha­sizes
Spontaneous Recovery that the students should be exposed to positive
stimuli in order to develop desirable habits,
The re-emergence of an extinguished conditioned
interests and attitudes in them.
response after a period of rest.
 Conditioning can also be used to remove
Stimulus Generalization unhealthy attitudes, superstitions and fears from
the minds of the students by exposing them to
A response to a stimulus that is similar to but different
positive stimuli (reconditioning).
from a conditioned stimulus; the more similar the two
stimuli, the more likely gene­ralization is to occur.
Pavlov theory has also been called as Type S Theory of Operant Conditioning (or)
conditioning to stress the significance of the stimulus Type ‘R’ Conditioning (or) Instrumental
that comes before and elicits the response. The Conditioning
theory of conditions as advocated by Pavlov, thus, The theory of learning by operant conditioning was
considers learning as habit formation and is based given by BF Skinner (1904-1990).
on the principle of association and substitution. It is Basically Skinner revolted against the concept of
simply a stimulus-response type of learning, where classical conditioning. He said that man is an active
in place of a natural stimulus like food, water, sexual organism, and not a victim of his environ­ment. He
contact, etc. an artificial stimulus like the sound of the does not wait for the stimulus; instead, he acts or
bell, sight of light of a definite color, etc. can evoke operates on the environment, so as to change it in
a natural response. When both the artificial stimulus some way. Thus, he called it as operant behavior
(ringing of the bell) and the natural stimulus (food) (Figure 3.13).
46 Psychology for Nurses

rat and operant behavior got esta­blished, i.e. the rat

continued to press the lever, in order to obtain the
food pellets (Figure 3.14). Based on the findings of
his experiments, he concluded that behavior is shaped
and maintained by its consequences. It is operated by
the organism and maintained by its results.

Reinforcement
The process, by which a stimulus increases the
probability that a preceding behavior will be repeated
(Table 3.1).
Figure 3.13: BF Skinner promoted the
behaviorist approach
Reinforcer
According to Skinner, operant behavior is
determined by the events or consequences that follow Any stimulus that increases the probability that a
the response. If the consequences are favorable, the preceding behavior will occur again.
individual will repeat the same behavior. In this case,
the consequences are said to have provided positive Positive Reinforcer
reinforcement and cause repetition of the behavior. A stimulus added to the environment that brings
Alternatively, if the consequences are unfavorable, about an increase in a preceding response.
they reduce the chances of the same behavior from
getting repeated. In such a case, the consequences Negative Reinforcer
are said to have provided negative reinforcement and An unpleasant stimulus, whose removal leads to an
reduce the chances of the behavior from recurring increase in the probability that a preceding response
again. will occur again in the future.
Thus, operant conditioning is called as type-R
conditioning, to emphasize the effect of the Punishment
response on future behavior. In this way Skinner
A stimulus that decreases the probability that a
said that learning is shaped and maintained by its
previous behavior will occur again.
consequences.
The following is one of the experiment carried
Schedules of Reinforcement
out by Skinner to support his concept of operant
conditioning. A hungry rat was placed in a box Objects or events, which provide reinforcement
designed by Skinner, which was called as the are called as reinforcers. There are two types of
Skinner box or operant chamber. The chamber reinforcers: Primary and secondary reinforcers.
contained a lever which would drop food pellets
into the chamber if pressed. In the beginning the
experimenter himself dropped the food pellets into
the box and later stopped. The rat, being hungry,
began to explore the box and pressed the lever
accidentally. The food pellet was released into the
box and the rat ate it up. After a while, it pressed
the lever again and ate the food pellet, which got
released. After the third or fourth time, the rat began
to press the lever more rapidly. Thus, the food is Figure 3.14: A Skinner box, used to study operant
said to have provided positive reinforce­ment to the conditioning
 Cognitive Processes 47
Table 3.1: Types of reinforcement and punishment
Effect on behavior
Procedure
Increases Decreases
Presentation of stimulus Positive reinforcement Positive punishment
Example: Giving a raise for good Example: Giving a punishment following
performance misbehavior
Result: Increase in frequency of Result: Decrease in frequency of response
response (good performance) (misbehavior)
Removal of stimulus Negative reinforcement Negative punishment
Example: Terminating a Example: Removal of favorite toy after
headache by taking aspirin misbehavior
Result: Increase in frequency of Result: Decrease in frequency of response
response (taking aspirin) (misbehavior)

™™ Primary reinforcers are those, which possess in- Fixed-Ratio Reinforcement Schedule
herent reinforcing properties. Examples include
In fixed-ratio (FR) reinforcement schedule, the
food, water, physical comfort, etc.
individual is reinforced following a ‘fixed’ number
™™ Secondary or conditioned reinforcers are those
of correct responses. This schedule usually generated
which acquire their reinforcing qualities through
extremely high operant levels in the individuals,
close association with a primary reinforcer.
because the more they respond, the more reinforcement
Examples of secondary reinforcers include
they receive. Example: Paying employees depending
money, attention, affection and good grades.
on the number of units they produce or sell.
Skinner put forward the idea of planning of
schedules of reinforcement in order to condition the
Variable-Ratio Reinforcement Schedule
operant behavior of the individual. The important
schedules are as follows: In variable-ratio (VR) reinforcement schedule,
reinforcement is intermittent and irregular. The
Continuous Reinforcement Schedule individual does not know when he is going to be
Continuous reinforcement (CR) schedule is 100 rewarded and so he remains motivated through out
percent reinforcement schedule, where every correct the learning process. The most common example
response of the individual is rewarded or reinforced. of this schedule is human behavior in gambling.
The learner is rewarded for every correct answer he Here rewards are unpredi­ctable and keep the players
gives to the questions put by his teacher. motivated, though returns are occasional.

Fixed-Interval Reinforcement Schedule Educational Implications of Operant

Conditioning Theory
In fixed-interval (FI) reinforcement schedule, the
individual is rewarded for a response only after a set  The key concept in Skinner’s theory is rein­
interval of time. What is important here is the fixed forcement. In order to enable an individual to
responses during this interval. For example: learn, the correct responses must be suitably
™™ Paying salaries for the work done on a weekly or rewarded or positively reinforced. Therefore,
monthly basis. the learning process and environment must be
™™ Conducting examinations periodically for the designed so as to create minimum frus­tration and
students. maximum satisfaction to the learner, to provide
™™ Giving a person a periodic allowance, etc. him with proper rein­forcement.
48 Psychology for Nurses

 The principle of operant conditioning may be it in its totality. The learner, while learning, always
successfully applied in behavior modification. We perceives the situation as a whole. After studying and
have to find something, which is rewarding for the evalua­ting the different relationships in the situation,
individual whose behavior we wish to modify, wait he takes the proper decision in an intelligent way
until the desired behavior occurs and immediately rather than simply reacting to specific stimuli.
reward him when it does. When this is done, the Gestalt psychologists used the term ‘insight’ to
frequency with which the desired response occurs describe the perception of the whole situation by
goes up. When the behavior next occurs, it is again the learner and his intelligence in responding to the
rewarded and the rate of response goes up even proper relationships. Insight is often referred to as
further. Proceeding in this manner, we can induce the end process of observational activity. Learning
the individual to learn the desired behavior. activities are said to be insightful for the desired
 Operant conditioning emphasizes the impor­tance learning. This reinforcement may be provided
of schedules in the process of reinforce­ment of through verbal praise, positive facial expressions of
behavior. In trying to impart or teach a particular the teacher, scores, grades, prizes, medals, etc.
behavior, great care should be taken for the proper In a nutshell, Gestalt psychologists tried to
planning of the schedules of reinforcement. interpret learning as a purposive, exploratory and
 This theory advocated the avoidance of punish­ creative process, rather than mere trial and error or
ment for unlearning the undesirable behavior and even conditioning. Learning is restructuring the field
for shaping the desirable behavior. Punishment of perception through insight.
proves ineffective in the long run. It appears The following are some of the experiments
that punishment simply suppresses behavior and carried out by Gestalt psychologists to support their
when the threat of punishment is removed, the view on learning:
rate with which the behavior occurs returns to its Kohler (Figure 3.15) put a chimpanzee in a cage
original level. Therefore, operant conditioning and a banana was hung from the roof of the cage.
experiments suggested appropriate alternatives to A box was placed inside the cage. The chimpanzee
punishment, in the form of rewarding appropriate tried to reach the banana by jumping, but could not
behavior and ignoring inappropriate behavior, succeed. Suddenly, he got an idea and used the box
for its gradual extinction. as a jumping platform by placing it just below the
 The theory of operant conditioning has shown banana (Figure 3.16).
that learning proceeds most effectively if: In another experiment, the problem was made
a. The learning material is so designed that it more difficult, and the chimpanzee had to use two
produces fewer chances for failure and more or three boxes to reach the bananas. Moreover, the
opportunities for success. placing of one box over the other required different
b. The learner is given rapid feedback concer­ning
the accuracy of his learning.
c. The learner is able to learn at his own pace.

Theory of Insightful Learning

(Gestalt Psychology)
Gestalt psychology was founded in Germany in 1912
by Max Wertheimer (1880-1943) and his colleagues.
The word ‘Gestalt’ means ‘form or shape or a
particular arrangement of elements’. The basic idea
behind Gestalt learning is that ‘the whole is more than
the sum of its parts’. Anything cannot be understood Figure 3.15: Wolfgang Kohler (1887–1967) chief exponent
by a study of its constituent parts, but only by viewing of theory of learning by insight
 Cognitive Processes 49

Figure 3.16: Kohler’s chimpanzee learns to reach the banana

specific arrangements. In a more complicated  Repetition and generalization.

arrangement, the banana was placed outside the  After reaching an insightful solution to a par-
cage. Two sticks, one longer than the other were ticular problem, the individual tries to repeat it
placed in the cage. One stick was hollow at one end, in another situation demanding similar type of
so that the other stick could be thrust into, forming a solution. The solution found in one situation
longer stick. The banana was kept at such a distance helps him to react insightfully in other situations.
that it could not be picked up by anyone of the sticks.
The chimpanzee first tried these sticks one after the Educational Implications of the Theory
other, but could not succeed. Suddenly, it got an idea of Insightful Learning
of joining the two sticks together and finally reached
the banana (Figure 3.17).  This theory emphasizes that trial and error learning
Based on their experiments the Gestalt must be minimized. The age-old mechanical
psychologists concluded that, on the whole, insight memorization and drill with lack of basic
depends on the following factors: understanding and use of creative mental abilities,
 Past experiences which help in the insightful must be stopped.
solution.  Subject must be presented in Gestalt form. Also, in
 Insightful solutions depend upon the basic the organization of the syllabus and planning of the
intelligence of the learner. The greater the curriculum, the Gestalt prin­ciple should be given
intelligence, the more is the insight. due consideration. A subject should not be treated
 Insight recurs when the learning situation is so as the mere collection of isolated facts or topics.
arranged that all the necessary aspects are open It should be integrated into a whole. Similarly, the
for observation. curriculum, comprising of different subjects and
 Insightful learning may initially pass through activities should reflect unity and inte­gration.
the process of trial and error. But this stage does  This theory has brought motivation to the forefront.
not last long. These initial efforts, in the form of The child should be motivated by arousing his
simple trial and error, open the way for insightful interest and curiosity, in order to make learning
learning. goal-oriented and effective.
50 Psychology for Nurses

Figure 3.17: Kohler chimpanzee learns to assemble a long stick from two shorter ones

 The learner must be given plenty of oppor­ According to Bandura, observational learning
tunities to use his mental abilities. The classroom takes place in four steps:
or environment, in which the child is learning  Paying attention and perceiving the most critical
is not just a body of discrete (separate) stimuli, features of another person’s behavior
nor are the child’s responses to the environment  Remembering the behavior
trial and error. The world is organized; it has a  Reproducing the action
meaning. The child can react with understanding;  Being motivated to learn and carry out the
he has insight. Thus, learning should be made behavior
meaningful. Instead of learning occurring through trial and
error, than, with successes being reinforced and
Cognitive Theory of Learning failures punished, many impor­tant skills are learned
through observational processes. For example, a
Observational Learning
girl happens to watch a TV program concerning the
Learning through imitation (social learning theory). preparation of some new dishes. First she observes
According to psychologist Albert Bandura and the demonstration of pre­paration of new dish on the
colleagues (1977), a major part of human learning TV screen and then tries to keep in her memory all
consists of observational learning; learning through that she has observed on the screen and then enters her
observing the behavior of another person called a kitchen to convert the stored observation into action.
model (Figure 3.18). Her learning of the preparation of the new dishes may
then be reinforced by the response she gets from the
members of her family, who taste the new dishes.

Summary of Various Theories

of Learning
Trial and error theory of learning, classical condi­
tioning and operant conditioning theories inter­
pret learning in terms of connection or association
between stimulus and response. Insightful learning
and obser­vational learning theories emphasize the
role of purpose, insight, under­standing, reasoning,
Figure 3.18: Albert Bandura exponent of memory and other cognitive factors in the process of
social learning theory learning (Table 3.2).
 Cognitive Processes 51
Table 3.2: Summary of various theories of learning
Theory Description
1. Trial and error theory of Learning is nothing but the stamping in of the correct res­ponses and stamping
learning out of the incorrect responses through trial and error
2. Theory of classical Learning occurs from associations between stimuli and response
conditioning
3. Theory of operant Learning is shaped and maintained by its consequences. Learning is a voluntary
conditioning response which is strengthened or weakened depending on its favorable or
unfavorable ­consequences
4. Theory of insightful Learning is a purposive, exploratory and creative process rather than mere trial
learning and error or even conditioning. Learning is restructuring the field of perception
through insight
5. Observational learning Learning occurs through obser­vational process. It advocates that most of what
we learn is acquired through simply obse­rving and imitating the behavior of
others who are taken as models

Learning Process learns something to change his behavior or to reach

Learning is a sequence of mental events leading to a a goal.
change in the learner. Along with the above steps individual readi­ness
is important for learning, i.e. physical and mental
Steps in Learning Process maturity. Some other steps involved in learning are
reinforcement and integration.
Learning process has continuity and is carried over
through various steps. According to HP Smith the Reinforcement: If the response is successful in action
learning process involves: in satisfying the need, that response is reinforced and
™™ A motive or drive on subsequent occasions the individual will tend to
™™ An attractive goal repeat it.
™™ A block to the attainment of the goal Integration: In this process the individual integrates
Motive: These are the dynamic forces that energize the successful responses with the individual’s
behavior and compel the individual to act. The previous learning, so that it becomes a part of a new
direction of learning will depend upon the relative functional whole.
strength of motives. Unsatisfied motives or needs Learning situation: Learning situation provides
compel the individual to satisfy them, which initiates opportunity for learning. The quality, speed and
a learner to learn something. effectiveness of learning depends much upon the kind
Goal: For satisfaction of needs the individual sets of learning situation and environment available to the
definite goals for achievement. The setting of learner. Healthy and favorable learning environment
goal helps in making the learning purposeful and brings satisfactory results in learning while the poor
interesting. The goal attracts the individual to learn. and unfavorable learning environment proves an
obstacle in the path of learning.
Block to the attainment of the goal: If the individual The process of learning does not end only with
faces no difficulty in attaining the goal, he will not the acquisition of certain knowledge, skill and
change his present behavior; this means there is no changes in behavior in one particular situation.
necessity to learn. If a block or barrier obstructs the Learning is a never ending process, the change once
individual to reach a goal then the individual will acquired or the learning once accomplished, gets its
try to change or modify his behavior. This means he fixation in other like wise situations. It stands for its
52 Psychology for Nurses

modification and thus seems always in a process of to region. If a child’s mother tongue is Tamil or Guja-
continuous change and develop­ment. rathi his pronunciation of English is affected by carry
over of Tamil or Gujarathi intonation.
TRANSFER OF LEARNING
Zero Transfer
Transfer of learning or training is a process by which
In case the previous learning makes no difference
learning or training in one situation is carried over or
at all to the performance or learning in a new
transferred to other situations. Example, the learning
situation, there is said to be zero transfer from the
of addition and subtraction helps the child in learning
previous situation to the new one. Example, learning
multiplication and division. Learning of mathe­matics
history may neither help nor hinder the learning of
helps in solving the numerical problems in physics.
economics.
Definitions
Factors Influencing Transfer
Transfer refers to the transfer of knowledge, training of Learning
and habits acquired in one situation to another
situation. (Sorenson—1948) Many factors influence the amount and direction of
The carry-over of the habits of thinking, feeling or transfer. Two important factors are:
working, of knowledge or of skills from one learning  Similarity of responses
area to another is usually referred to as the transfer of  Similarity of stimuli
training. (Crow and Crow—1973) a. When both the stimuli and responses in tasks
are similar, learning of one facilitates the
Types of Transfer learning of the other.
b. When both stimuli and responses are different,
There is no guarantee that learning in one situation or the learning of one has no effect on the learning
in one field will always help the learning in another of other.
situation or field. Sometimes the learning of one task c. If responses are identical but stimuli are
creates difficulty in performing or learning another different, the learning of one aids in the
task. Having learned to pronounce ‘but’ correctly, the learning of the other task.
child finds it difficult to pronounce ‘put’ correctly. In d. Maximum negative transfer is observed, when
this way transfer of training or learning also affects the stimuli are the same but the responses are
besides the positive and favorable ones. Transfer is different.
said to have the following three forms:
 Positive transfer Some Other Factors are:
 Negative transfer
 Degree of transfer is closely related to the
 Zero transfer
learner’s intelligence.
 Formation of attitudes and ideals helps one to
Positive Transfer
transfer the knowledge and the skill from one
Transfer is said to be positive, when something situation to another.
previously learned benefits performance or learning  Proper study habits have to be developed so
in a new situation. Example, if one has learned to play that students try to see the relationship between
tennis he finds it easier to learn to play badminton. various situations and try to apply what they
know to other situations.
Negative Transfer  Transfer relies heavily on meaningfulness of
When something previously learnt hinders per- materials.
formance or learning in a new situation, we call it  Methods of teaching-student centered method
negative transfer. Example, in India we find that the of teaching will help to know the relationship
pronunciation of English words varies from region between things.
 Cognitive Processes 53
Theories of Transfer of Learning another situation. Thus, transfer results from the
application of general ideas or skills or habits or
Apperception Theory of Transfer attitudes. Transfer through generalization is possible
According to apperception theory of transfer, only when systematization and organization of
learning results in the storage of ideas, expe­ the knowledge and skill take place. If they are not
riences, etc. (called apperceptive mass) into one’s systematized, they have little transfer value in other
unconscious mind and their strengthening with situations. It will depend upon the individual’s ability
repetition. Such strengthened apperception mass to generalize his experience. Thus, it is positively
then leads automatically to its transfer in the relevant related to intelligence.
learning situation. Mere technique of generalization however may
not bring about the transfer effect in all situations.
The Theory of Identical Elements or Identical Example: Hema who is extremely methodical in her
Components office work, may be quite disorderly and chaotic in
According to theory of identical elements of her house. This happens because generalization is not
Thorndike, there is transfer from one situation to accompanied by an ideal and does not have emotional
another to the extent that the same elements or content. ‘Bagley’ has therefore emphasized transfer
components are found in different situations. These through the formulation of ideals and attitudes. A
identical elements may be in the form of content or child, who is punctual as far as school routine is
technique. concerned, may not be punctual in out of school
situations. This may happen because punctuality is
Similarity of content: The study of ‘Sanskrit’ helps not stressed as an ideal. Generalized concepts such
one with the study of Hindi or Kannada to an extent as honesty, neatness or punctuality should be stressed
as the two languages contain identical components not in specific situations but rather as an ideal.
such as vocabulary or grammatical constructions.
Similarity in technique: Skill acquired in playing Transposition Theory of Transfer
hockey may be useful in playing football to the Transposition theory of transfer has been propagated
extent that there are common elements such as by Gestalt field psychologists; they emphasized
running, judging the course of the ball and general the role of insight in the mechanism of transfer of
physical ability. The skill acquired by the right hand learning. They asserted that in transfer, the identical
transferred to the left hand is called as bilateral elements or generalizations do not get transferred
transfer. The amount of transfer will depend on auto­matically unless one has developed the proper
the extent of similarity between the two situations. insight of using and employing them and is desirous
Greater the similarity, greater the transfer effect. In to transfer it at the right time. This process of gaining
typing, for example, one can transfer his skill from or developing insight into the use of concepts and
one type of machine to another easily, but it may generalizations in one situation and employing it
not be so easy in case of driving two cars having afterwards in other situations is called transposition
different gear shifts. The amount of transfer will and it is this transposition of insight, which can be a
differ in the two cases. Sometimes, little transfer medium or a base for the transfer of learning from
occurs because the individual fails to detect the one situation to another.
under­lying similarities in two situations. Remember
that transfer is not automatic. Theory of Ideals
Theory of ideals says that neither the isolated nor the
Theory of Generalization generalizations but the ideals get transferred from
According to the theory of generalization, transfer one learning situation to another. That is why it gives
occurs, when a person learns a principle or an proper weightage to the development of desired
idea in one situation and then is able to apply it in attitudes and ideas about the things in the form
54 Psychology for Nurses

of ideals for being transferred from one learning telling the students that the material they were
situation to another. learning would be useful in other situations.
 Teachers should remember that transfer is not
Educational Implications of accomplished with equal facility or in equal
Transfer of Learning amounts by all individuals. It depends upon
The mechanism of transfer of learning has wide one’s ability to generalize his experiences and
educational implications for both the teachers and the ability to perceive relationships between
the learners as they come to realize that transfer two situations. It is thus positively related to
helps in better teaching and learning. Learning in one intelligence.
situation is capable of exercising positive or negative  Emphasis should be given on developing ideals
influence over the learning in another situation. and attitudes.
As far as possible efforts should be made to  Teachers are ordinarily advised not to present
seek positive transfer value of the learned thing by in close succession methods or ideas, which
avoiding the negative ones. The extent of transfer might easily be confused and thus cause negative
of an academic subject clearly depends upon the transfer. In solving a problem if two methods
teaching methods. Teaching for transfer of learning are shown in succession without properly fixing
requires empha­sizing the following principles: the first, there is interference while learning the
 Emphasizing the similarities between the current second method and the student gets confused.
subject and the situations, to which the new The following suggestions can help the learner to
learning will transfer. achieve maximum positive transfer:
 Transfer takes place because of similarity of  What is being learned at present, should be linked
content, technique, method or generalization. If a with what has already been learned in the past.
student fails to detect the similarity between two  While engaging in learning, the learner should
situations, transfer will not take place. Transfer try to have integration of the theoretical studies
of learning does not take place automatically. with practical experiences.
We have to teach keeping transfer of learning in  Learning should be properly correlated with life
mind. experiences, environmental surroundings and
 Specific facts must be taught, with arriving at other areas of study and knowledge.
meaningful generalization.  The learner should identify identical compo­nents
 Teachers should provide varied experiences. between the two learning situations.
 As much as possible learning experiences must  The learner should avoid rote learning. He must
be made similar to life-like situations. develop the habit of learning through proper
 Sometimes opportunities for transfer are lost understanding and insight.
because teachers do not alert students to look for  Learner should never hesitate to utilize the
relationships and to see how material, which is learning of one field in the learning of other
being learned can be of use in the future. In the fields.
teaching of regional languages, teacher should  Instead of learning discrete and isolated facts, the
show how many of the words are derived from learner should concentrate on the learning of the
Sanskrit roots. principles, generalizations and rules.
 It is now well established that greater transfer  Learner should try to gain proper knowledge and
from subject matter can be achieved by changing insight into making distinctions between positive
the methods of teaching. If the subject matter and negative transfer of his learning.
is taught in isolation from the problems of  As far as possible, he should seek the maxi­mum
daily life, the utility of the knowledge gained positive transfer of his learning or training by
is extremely limited. In one study 16 percent saving himself from the ill-effects of negative
increase in transfer was obtained by simply transfer.
 Cognitive Processes 55
Study Habits when new words appear, the meanings should be
A student nurse must bear in mind the following noted down and an effort be made to use them
points for her learning to be effective: effectively. The student nurse should also be able
 Being Self-prepared: Sound physical and mental to study the charts and tables and remember the
healths are pre-requisites for good study. Besides formulae, when required.
this the student nurse should also have capacity  Proper physical surroundings: If the place of
for hard work. study is fixed and the hours of study regular,
 Wholeness: It is recommended to have a bird eye- one can easily get into the mood for study.
view of the complete subject before going into The surroundings should invariably be sober,
details of the study. Dr Buchanan has suggested clean and adequately illuminated. Poor light,
that the entire course outlines be skimmed in bad ventilation, extreme heat and cold reduce
order to select main ideas of the whole course efficiency in learning.
and find the parts, which deserve close study. ⓫ Interrelationship: Interrelationship and correla-
 Planning and organization: The student nurse tion among various subjects such as anatomy,
should have a time-table for the whole day with physiology, chemistry is conducive to effective
a definite period for study. The time selected learning. The student nurse should also know
should be such that the chances for disturbance how it is useful in studying the patient. All old
are minimum. knowledge must be related with the new.
 Clarity of purpose: The student nurse should be
clear about, what she is learning and associate Studying for Examination
with as many issues as possible. In particular she Points to be kept in mind, while studying for
must know, how the piece of learning will help examinations are:
her in the career.  Attitude should be positive and thinking hopeful.
 Prompt start: When one has to study one should  All nervousness should be avoided and it is
get down to it without delay and not waste any better not to study any thing few hours before the
time in trivia. examination.
 Search for essentials in an assignment: The  Keeping awake the previous night should be
students must always look for the basic facts of avoided as lack of sleep and nervous exhaus­tion
the subject study and give due importance to the distorts one’s judgment.
general principles as well as details.  Cramming should be avoided as there is no
 Note-taking: Students should cultivate the habit intelligent learning or grasp. It is mechanical in
of taking notes while studying. Intelligent note- nature. Useful study consists of constant review
taking lends seriousness to the study and helps and should be reflective.
the student to think and reason. Notes should be
brief and concentrate on the vital ideas. MEMORY
 Review and over learn: The rate of forgetting
is far in excess of what is retained. Therefore, Memory plays a very important role in our learning
constant review is required to retain the essentials and psychological growth. Through memory of
of any subject. Besides one must learn more than our past experiences, we handle new situations;
what is necessary. It is advisable to read the same it helps us in our relearning problem solving and
topic from many books and also recall what has thinking. Memory is regarded as a special ability
been learned. If the recall is unsatisfactory the of our mind to conserve or store what has been
lesson should be revised. Over learning is helped previously learned or experienced to recollect or
by repeti­tion and recitation. reproduce it after sometime. Memory is a complex
 Paying attention to words, charts, tables and process, which involves learning, retention, recall
formulae: During the course of the study as and and recognition.
56 Psychology for Nurses

Definitions meaning, pattern and other characteristics. With the

Memory consists in remembering what has previ- help of LTM we can store, retain and remember most
ously been learned. of the things in our life, at record notice and thus
(Woodworth and Marquis—1948) make things quite easy.
The power that we have to ‘store’ our expe­riences, Long-term memory can be categorized into de-
and to bring them into the field of consciousness clarative and procedural memory. While informa-
sometime after experiences have occurred, is termed tion about things is stored in declarative memory,
memory. (Ryburn—1956) information regarding how to do things is stored in
Memory and remembering carry the same procedural memory. Declarative memory can be fur-
meaning. While differentiating between memory ther subdivided into semantic memory and episodic
and remembering, Levin (1978) says “Memory can memory (Figure 3.20).
be compared to a giant filing cabinet in the brain,
with data stored, classified and cross-filed for future Nature of Memory
reference. Remembering depends upon how the Following are the fundamental characteristics of the
brain goes about coding its input”. memory process:
 Memory involves input – registering or encoding
Types of Memory information, where a memory trace is formed
™™ Immediate memory or sensory memory from translating the sensory data.
™™ Short-term memory (STM)  Storage – it is either temporary or permanent.
™™ Long-term memory (LTM) (Figure 3.19)  Output – it involves retrieval – memory would be
useless unless they could be retrieved.
Immediate or Sensory Memory Other factors involved in memory process are:
a. Learning or registration
Immediate memory or sensory memory is that
b. Retention
memory, which helps an individual to recall
c. Recall
something a split second after having perceived it.
d. Recognition
In such type of memory retentive time is extremely
brief generally from a fraction of a second to several
Learning or Registration
seconds.
Immediate memory is needed, when we want to Our mind has a special ability by virtue of which
remember a thing for a short time and then forget every experience or learning leaves behind traces,
it, which helps us to learn a thing immediately with
speed and accuracy. For example, we look up a
telephone number from the directory and remember
it, but after making the call, we usually forget it.

Short-term Memory
Short-term memory (STM) holds a relatively small
amount of infor­mation, about seven items, for a short
period of (20–30 seconds) time though not nearly as
short-lived as the immediate memory.

Long-term Memory
Long-term memory (LTM) has the unlimited capacity
to store infor­mation for days, months, years and
even a lifetime. LTM codes information according to Figure 3.19: Three stage model of memory
 Cognitive Processes 57
which are conserved in the form of ‘engrains’. This the one needed was finally recalled or reproduced
is known as learning. and recognized. It is recognized by us in the sense
that we knew that the recalled name was the one,
Retention which we wanted to recall. Of these three aspects of
These engrains or memory traces are preserved in memory, the most important is the ability to recall or
our brain with the help of our nervous system. This reproduce.
process is known as retention.
Factors Influencing Memory
Recall Memory refers to process of remembering. The
Recall means perfect revival of the past experiences. factors, which influence memory are divided into
extrinsic factors and intrinsic factors.
Recognition
Recognition means that the recalled experience Extrinsic Factors
at the conscious level is the same from which the Meaningfulness of material to be memorized:
individual wanted to recall and had experience  What is useful, meaningful and suits the needs,
earlier. Recall and recognition are closely related. motives and purposes of an individual can be
Recall provides the material in memory, while learned properly retained for a long time and may
recognition is the process of accepting or rejecting be reproduced easily, when needed.
it. Recall is an active process, recognition is more a  Similarly the material in the form of sentences,
passive behavior. paragraphs or longer passages or skills in the
For example, remembering a person’s name. form of any actions can only be effectively
This means the name was learned by us at some managed and memorized, if they are meaning­ful.
previous time. It was retained in the mind, when we  Such meaningful material draws the attention
did not think about it. We needed this name again. of the learner, creates a sense of will power and
Many similar names will come before our mind; arouses his interest in learning, retaining and
reproducing the material.
Amount of material to be memorized: Success in the
task of effective memorization depends to a great
extent upon the size and quantity of the material
to be memorized. If the amount of material under
memorization falls within the reasonable limit of
the individual’s memory, satisfactory result can be
achieved, but in case it crosses one’s reasonable limit
no such result is likely to be achieved.
The greater the amount, the greater efforts in
memorization it needs and the greater possibility
of failure in terms of learning, retention and
reproduction. Therefore, it is always safer to have a
convenient amount of the material for memori­zation
at a particular sitting.
Time required to vocalize responses: Memory span
is consistently higher for short words than for long
words. This increase is due to the decreased amount
Figure 3.20: Classifications of long-term memory of time needed to pronounce the shorter words.
58 Psychology for Nurses

Distraction: Greater the distraction present in the Brain tumors: This is a disease that causes the
situation, the poorer would be the performance of patients to forget people’s names they interact with
the individual. Alternately, either a calm and quite everyday or places that they go to everyday.
atmosphere or a stimulating environment proves to
Alzheimer’s disease: This is the most common cause
be an effective aid to learning.
of memory loss. Nerve cells are degenerated in this
disease.
Intrinsic Factors
Attention deficit disorder (ADD) and attention deficit
Age of the individual: This is a factor, which definitely
hyperdisorder (ADHD) are conditions that affect a
affects memory span. Investigators claim that memory
person’s ability to learn and remember.
span increases between the 16 and 26 years level.
Youngsters can remember better than the aged. Certain diet related problems that can cause
memory loss or weak memory are as follows:
Maturity: Very young children cannot retain and
 Nutrient deficiencies—deficiency of certain
remember complex material.
minerals, vitamins and other nutrients can cause
Will to learn: Material read, heard or seen without cognitive problems and also contribute to the
genuine interest or inclination is difficult to be beginning of Alzheimer’s disease. A deficiency
remembered or recalled at a later time. of minerals and vitamins including iron, zinc, B
Interest and attention: Interest as well as attention vitamins – B12, B6, folate, selenium, vitamin E
is essential for learning and memorization. A person and iodine can cause difficulties in concentrating,
who has no interest in what he learns, will not give recalling, risk of developing Alzheimer and low
due attention to it and consequently will not be able level of oxygen in the brain.
to learn it.  Alcohol—acts as a depressant by slowing down
reaction time and thought processes. Short-term
Intelligence: More intelligent person will have better memory is affected by excessive drinking.
memory than a less intelligent person. The other conditions that lead to cognitive problems
Rest and sleep: Adequate sleep and rest helps to are:
relieve fatigue and monotony. A mind which is fresh  Some drugs like benzodiazepines can cause
is naturally able to learn more and retain it for a temporary memory disturbance.
longer period than a mind which is dull and fatigued.  A psychological problem like patients with
anxiety and depression suffer with memory
Medical conditions: Major causes for memory loss
impairment.
are contributed by medical conditions and eating
 Head injury.
habits.
High blood pressure: This condition leads to the Theories of Memory
hardening of the arteries. This does not aid the Theories of memory provide abstract representations
flow of blood to the various parts of the body as it of how memory is believed to work. Below are
is supposed to. The circulation problem thus caused the theories proposed over the years by various
can lead to memory loss as the blood that carries psychologists:
oxygen and other nutrition to the brain does not
reach it. Such effects on the circulation system can Theory of General Memory Functions
also lead to a stroke, which is the major cause for Theory of general memory functions focuses on three
dementia. Dementia can leave a person with severe distinct processes of memory; these are an encoding,
memory impairment. storage and retrieval (Figure 3.21).
Hypothyroidism: This is a condition caused, when  Encoding is the process of receiving sensory
not enough thyroid hormone is produced. The most input and transforming it into a code, which can
common symptom of memory loss is hypothyroidism. be stored.
 Cognitive Processes 59
 Storage is a process of actually putting coded This theory has been criticized for being too
information into memory. simplistic. For instance, LTM is believed to be
 Retrieval is the process of gaining access to actually made up of multiple subcomponents, such
stored coded information when it is needed. as episodic and procedural memory. It also proposed
Memory is seldom an accurate record of what was that rehearsal is the only mechanism by which
experienced. information eventually reaches long-term storage,
but evidence shows that it is capable of remembering
Information Processing Theory things even without a rehearsal (Figure 3.22).
 Information processing theory was developed by
Richard Atkinson and Richard Shiffrin (1968). Levels of Processing Theory
According to this theory memory starts with a  Craik and Lockhart (1972) proposed that memory
memory input from the environment. occurs on a continuum from shallow to deep,
 This input is held for a very brief time – several with no limit on the number of different levels.
seconds at most in a sensory register associated  The shallow or superficial levels store informa-
with the sensory channels (vision, theory, touch tion about identity of phenomena, including
and so forth). numerous attributes. These may be associated
 Information that is attended to and recognized in with a word or an image. The shallow levels in-
the sensory register may be passed on to STM, volve analysis in terms of physical or sensory
where it is held for 20 to 30 seconds. characteristics, such as brightness or pitch.
 Some of the information reaching STM is  The intermediate level of memory relates to
processed by being rehearsed, i.e. by having recognition and labeling.
attention focused on it, perhaps by being repeated  The deep level is the storage of meaning and
over and over or being processed in some other
networks of association. Deeper processing
way that will link it up with other information
results in more elaborate, long lasting and
already stored in the memory.
stronger memory traces. When the learner
 Information that is rehearsed by then is passed
analyzes for meaning he may think of other,
along to LTM. Information not so processed is
related associations, images and past experiences
lost.
related to the stimulus.
 The information, which is placed in LTM will be
 Factors which influence the depth of perceptual
organized into categories, where they may reside
processing include the amount of attention
for days, months, years or for a life time. When
devoted to the stimulus, its compatibility with
we remember something, a representation of the
existing memory structures in the learner’s brain,
item is withdrawn or retrieved from LTM.
and the amount of processing time available. In
addition, the “self-reference effect”, in which

Figure 3.21: Stages of memory Figure 3.22: Information processing theory

60 Psychology for Nurses

new information is related to the learner himself, method is found to be better than the part method in
takes learning to deeper levels and therefore case of a short poem, while the part method proves
promotes LTM. more advantageous, if the poem is a larger one.
Craik and Lockhart also discussed rehearsal, the
process of cycling information through memory. Space and Unspaced Method
Craik and Lockhart proposed two kinds of rehearsal. In the spaced or distributed practice method of
Maintenance rehearsal merely repeats the kind memorization, the principle of ‘work and rest’ is
of analysis that has already been carried out. In followed. For example, if one has to memorize a
contrast, elaborate rehearsal involves a deeper, more piece of poetry by this method, he will be advised to
meaningful analysis of the stimulus. Elaboration is go on repeating it, after sometime he will be given
the process of adding more extensive information some rest.
into the memory system. This serves to make On the other hand, in unspaced or massed
existing information and incoming information more practice method of memorization the subject has
distinctive and unique (Figure 3.23). to memorize the assigned material in one sitting
Craik and Lockhart gave three examples of levels without any rest. It has been observed that instead of
in which verbal information can be processed: working continuously without taking rest, it is better
™™ Structural – this is shallow processing, looking at to distribute the hours of work in these sittings and
what the words only look like. introduce the periods of rest in between these settings.
™™ Phonetic – processing the sound of the word. This helps in removing the monotony caused by long
™™ Semantic – this is deep processing, considering periods of study. Moreover, the subject gets a fresh
the meaning of the word. start after a period of rest and thus his interest can be
maintained in the task.
Methods of Memorizing
Success in the process of memorization depends Repetition and Practice
much on the methods of learning or memorization An intelligent repetition with full understanding
adopted by the learner. The choice of a particular always helps in achieving better results in the process
method for bringing better results depends upon of memorization. The things repeated and practiced
many factors like, the nature of the learner, the frequently are remembered for a longer time in
learning material and the learning situations, etc. comparison to those for, which little or no time is
spent for repetition and practice.
Whole and Part Method
There are two methods of memorizing a thing, for Making Use of the Principle of Association
example a poem. One is to read the poem again and It is always good to follow the principle of association
again from the beginning till the end as a whole. in learning or memorization. Always attempts should
In the other method–the poem is divided into parts be made to connect it with one’s previous learning
and each part is memorized separately. The whole on the one hand and with so many related things on
the other. Sometimes for association of ideas special
techniques and devices are used for recall. For
example, ‘CAUTION’ for cancer symptoms.

Grouping and Rhythm

Grouping and rhythm also facilitate learning and
help in remembering. For example, a telephone
number 567 345 234 can be easily memorized and
Figure 3.23: Levels of processing theory recalled if we try to group it as 567 345 234.
 Cognitive Processes 61
Similarly rhythm also proves as an aid in learning from that, pick the first letter from each word and
and memorizing. Children learn multi­plication tables combine them to get KMMC.
in the sing song fashion effec­tively. The arrangement
of the material in the form of a verse with rhythm and Acrostic
rhyme is found very useful in this direction. An invented sentence, where the first letter of each
word is a clue to an idea you need to remember.
Recitation Acrostics are especially useful for long lists of
After reading a lesson a few times, the student must things whose names don’t begin with vowels. For
try to review the whole thing without the help of a example, to remember the bones of the skull the
book; this method is referred to as self-recitation. acrostic sentence can be – Old People From Texas
Several studies have shown that self-recitation is Eat Spiders – Occipital, Parietal, Frontal, Temporal,
a more economical use of one’s study time than Ethmoid and Sphenoid.
mere re-reading. This method not only economizes
the energy to be applied, but also helps towards Mnemonics
permanent retention. Mnemonics is another word for memory tool. Mne-
monic are techniques for remembering informa-
Utilizing as many Senses as Possible tion, i.e. otherwise quite difficult to recall. The idea
Things are better learnt and remembered, when behind using mnemonics is to encode difficult to
they are presented through more than one sense. remember information in a way that is much easier
Therefore attempt should be made to take the help to remember.
of audio-visual aid material and receive im­pressions Mnemonic link system: A method of remembering
through as many senses as possible. lists, based on creating an association between the
elements of that list. For example, if one wished
Pulling at all Together to remember the list (dog, envelope, thirteen, yarn,
Organizing and ordering information can signifi- window), one could create a link system, such as a
cantly improve memory. Learning a large amount of story about a “dog stuck in an envelope mailed to an
unconnected and unorganized information from vari- unlucky black cat playing with yarn by the window”.
ous classes can be very challenging. By organizing This story would be easier to remember than the list
and adding meaning to the material prior to learning itself.
facilitate both storage and retrieval.
Memory peg system: A technique for memorizing lists.
The main idea of these systems is to establish longterm
Funnel Approach
memory, a well organized set of images to which the to
The funnel approach means learning general con- be remembered items can be linked. In number systems,
cepts before moving on to specific details. When you form an image with each number. For instance, a
we understand the general concepts first, the details rhyming system can be used for the numbers 1 through
make more sense. 10. think of words that rhyme with the numbers—1 is
bun, 2 is a shoe, 3 is a tree, 4 is a door and so on. Now
Acronym when you have a list to remember, you can associate the
Acronym is the method of creating combination items on the list with your images of the numbers, you
of letters so as to recall certain enumerations. For can associate the items on the list with your images of
example, to memorize the parts of a computer make the numbers. If the first item on a grocery list is coffee,
a list, for example, keyboard, mouse, monitor and imagine a streaming cup of coffee next to a plate of
central processing unit (CPU). To make an acronym buns; if the second item is hamburger, you might see
62 Psychology for Nurses

a giant shoe squashing hamburger into a patty and so Definitions

on through the list, associating the number images with Forgetting is the loss, permanent or temporary, of
what is to be remembered. the ability to recall or recognize something learned
Method of loci: ‘Loci’ is otherwise known as earlier.
locations. The method of loci is also commonly  (Munn–1967)
called the mental walk. It is a method of memory Forgetting means failure at any time to recall an
enhancement, which uses visualization to organize experience, when attempting to do so or to perform
and recall information. In this technique the subject an action previously learned. (Drever–1952)
memorizes the layout of some building or the
arrangement of shops on a street or any geographical Types of Forgetting
entity, which is composed of a number of discrete Forgetting is just the opposite side of remembering
loci. When desiring to remember a set of items and essentially a failure in the ability of repro­ducing.
the subject literally ‘walks’ through these loci and It is classified as:
commits an item to each one by forming an image ™™ Natural forgetting and
between the items and any distinguishing feature of ™™ Morbid forgetting (abnormal)
that locus. Retrieval of items is achieved by ‘walking’
through the ‘loci’ allowing the latter to activate the Natural Forgetting
desired items.
Forgetting occurs with the lapse of time in a quite
Chunking: This is a technique generally used, when normal way without any intention of forgetting on
remembering numbers. It is based on the idea that the part of the individual.
STM is limited in the number of things that can
be contained. A common rule is that a person can Morbid Forgetting (Abnormal)
remember 7 (plus or minus 2) ‘items’ in STM. In Person deliberately tries to forget something
other words, people can remember between 5 and (repression).
9 things at one time. When you use ‘chunking’ to According to some other view, forgetting may be
remember, you decrease the number of items you classified as general or specific:
are holding in memory by increasing the size of each ™™ In general forgetfulness one suffers a total loss in
item. In remembering the number string 64831996, one’s recalling some previous learning.
you could try to remember each number individually ™™ In specific forgetfulness the individual forgets
or you could try thinking about the string as 64 83 only one or the other specific part of his earlier
19 96 (creating ‘chunks’ of numbers). This breaks learning.
the group into a smaller number of ‘chunks.’
Instead of remembering 8 individual numbers, According to Another Classification
you are remembering four larger numbers. This is
™™ In physical forgetfulness one loses his memory
particularly helpful when you form ‘chunks’ that
on account of the factors of age, disease, bio-
are meaningful or familiar to you (in this case, the
logical malfunctioning of the brain and nervous
last four numbers in the series are ‘1996’, which can
system, accidents, consumption of liquor or other
easily be remembered as one chunk of information).
intoxicating materials, etc.
™™ In psychological forgetfulness one loses his
Forgetting memory on account of factors like stress, anxiety,
Forgetting means a failure to recall a fact, an idea, or conflicts, temper provocation, lack of interest,
a group of ideas. It is the weakening of the bonds that apathy, repression or similar other emotional and
were formed in learning. psychic difficulties.
 Cognitive Processes 63
Causes of Forgetting conditions at the time of learning and reproduction.
 Inadequate impression at the time of learning: These factors make the material easily slip out of the
Inadequate or improper learning is likely to be mind.
forgotten. Intention or will is the most impor­
tant factor in remembering a thing. Forced Theories of Forgetting
learning either results in no learning or has a very
temporary effect. Trace Decay Theory
 Lapse of time: Time is said to be a great healing According to many psychologists, time is the cause
factor. What is learned or experienced is forgotten of much forgetting, what is learnt or experienced is
with the lapse of time. forgotten with the lapse of time. The cause of such
 Interference of association: We forget something natural forgetting can be explained through a process
because what we have learned previously known as decay of the memory trace. It says that
interferes with the remembering of what we learning results in neurological changes leaving
learn afterwards. We also forget because we tend certain types of memory traces or engrams in the
to learn new things all the time and new learning brain. With the passage of time through disuse, these
interferes in the retention of old learning. memory traces of learning impressions get weaker
 Rise of emotions: Emotions play a key role in and weaker and finally fade away. It leads us to
learning as well as in forgetting. Sudden rise of conclude that the older an experience, the weaker its
emotions in excess blocks the process of the recall. memory and as time passes, the amount of forgetting
 Poor health and defective mental state: goes on increasing.
Deterioration in health makes an individual This theory has proved a failure in many
less confident and more perturbed. He remains instances of forgetting. In LTM, such as learning to
under the state of tension and thus is unable to ride a bicycle forgetting does not occur even after
concentrate upon a thing at a particular time. years of neglect. However, this theory has provided
Neither is he able to learn it effectively nor can good results in explaining forgetfulness in the case
he recall it easily after some time. People having of STM. Drill, practice, rehearsal or repetition of
lower intelligence quotient (IQ) or suffering from learning always results in preventing decay.
mental defects have been generally found to be
very poor in retention and recall. In some cases a Interference Theory
brain injury may also become a sole cause for the Mechanism of interference is responsible for
loss of memory. In such cases people are found forgetting. Interference is caused on account of the
to forget all about their previous experiences and negative inhibiting effects of one learning expe­
happenings. rience on another. We forget things because of
 Inadequate repetition or practice of learning such interference. The interfering effects of things
material: We forget facts which we do not previously learnt and retained in our memory with
subsequently make use of. We forget because the things of our recent memory can work both ways,
of inadequate repetition or practice of learning backward and forward. The psychological term used
material that has been over learned with long for these types of interference is retroactive inhibition
hours of studying one thing, without changing and proactive inhibition.
the subject. Studying without proper spacing  In retroactive inhibition the acquisition of new
strains our nerves and results in fatigue. learning works backward to impair the retention
In addition to factors mentioned above, there are of the previously learned material. For example,
many others which result in forgetfulness. They a second list of words, formu­lations or equations
include fatigue, long illness, forces of distraction, may impair the retention of a first list.
lack of interest and purpose, lack of willingness or  Proactive inhibition is just the reverse of
intention to learn or recall, unfavorable situations or retroactive inhibition. Here the old learning
64 Psychology for Nurses

or experiences retained in our memory works emotional behavior of an individual also plays its
forward to disrupt the memory of what we acquire part in disrupting the normal memory process. For
or learn afterwards. For example, learning a new example, a sudden rise of emotions in excess, may
formula may be hampered on account of the completely block the process of recall. When one is
previously learned formulae in one’s memory. taken over by emotions like fear, anger or love, one
In both the types of inhibitions, it can be easily may forget all he has experienced, learned or thought
seen that similar experiences, when follow each other before hand. During these emotions one becomes so
produce more interference than dissimilar expe­ self-conscious that his thinking is paralyzed. That is
riences. Because in this case all experiences are so
intermingled that a state of utter confusion prevails in
the mind of an individual and consequently he faces Table 3.3: Summary of decay and interference theories
a difficulty in retention and recall (Figure 3.24). Decay theory Interference theory
Interference theory as a whole has been proved Forgetting occurs Proactive interference:
quite successful in providing adequate expla­nation because as time Material learned initially
for natural and normal forgetting for both the STM passes, the memory prevents you from recalling
and LTM (Table 3.3). trace gradually material learned later (for
fades away. A name example, Spanish words
you once knew, interfere with your memory
Repression Theory for instance, is no of French words that were
The ‘repression theory’ was put forward by Freud’s longer available for learned later)
psychoanalytic school of psychology. Repression, recall because the
physiological basis Retroactive interference:
according to this school, is a mental function that for the memory has Material learned after
safeguards the mind from the impact of painful eroded previously learned material
experiences. As a result of this function we actually prevents you from recalling
push the unpleasant and painful memories into the the previously learned
unconscious and thus try to avoid at least consciously material (for example,
you cannot remember
the conflicts that bother us. This leads to forgetting someone’s phone number
things, which we do not want to remember. given to you at the beginning
People under a heavy emotional shock are seen to of a party because activities
forget even their names, homes, wives and children. that occurred later block
Apart from causing abnormal forgetting, the impaired your memory)

Figure 3.24: Interference theory

 Cognitive Processes 65
why a child fails to recall the answer to a question in Reflective Thinking or Logical Thinking
the presence of a teacher whom he fears very much.
Reflective thinking aims at solving complex problems
rather than simple problems. It requires reorganization
THINKING of all the relevant experiences and finding new ways
Thinking is a complex mental activity. It is symbolic of reacting to a situation. Mental activity in reflective
in character, initiated by a problem, which the thinking does not undergo any mechanical trial and
individual is facing, involves the response of the error type of effort. There is an insightful cognitive
individual to this problem. approach in reflective thinking. It takes logic into
account, in which all the relevant facts are arranged
Definitions in a logical order so as to arrive at a solution to the
problem in hand.
Thinking is behavior, which is often implicit and
hidden and in which symbols (images, ideas and Creative Thinking
concepts) are ordinarily employed. (Garrett—1968)
Thinking is a problem solving process, in which we Creative thinking is chiefly aimed at creating
use ideas or symbols in places of overt activity. something new. It is in search of new relationships
(Gilmer—1970) and associations to describe and interpret the nature
of things, events and situations. It is not bound by
any pre-established rules. The individual himself
Types of Thinking
usually formulates the problem and is free to collect
Thinking, as a mental process, is usually classified evidence and invent tools for its solution. The
into the following types: thinking of the scientists or inventors is an example
™™ Perceptual or concrete thinking of creative thinking.
™™ Conceptual or abstract thinking
™™ Reflective or logical thinking Critical Thinking
™™ Creative thinking
™™ Critical thinking Critical thinking is a higher order well-disciplined
thought process, which involves the use of cognitive
Perceptual or Concrete Thinking skills like conceptualization, interpretation, analysis,
synthesis and evaluation for arriving at an unbiased,
Perceptual thinking is the simplest form of thinking.
valid and reliable judgment of the gathered or
The basis of this type of thinking is perception,
communicated information or data as a guide to
i.e. inter­
pretation of sensation according to one’s
one’s belief and action.
experience. It is also named as concrete thinking as
it is carried by the perception of actual or concrete
objects and events. It is thinking of a lower order. Such
Two Main Types of Thinking
type of thinking is present in animals and children.  Controlled thinking
 Free thinking
Conceptual or Abstract Thinking
Like perceptual thinking it does not require the Controlled Thinking
perception of actual objects or events. It is an In controlled thinking the process of thinking is
abstract thinking where one makes use of concepts, controlled and regulated. Thoughts keep in close
the generalized ideas and language. It is regarded as touch with reality and are directed towards the
a superior type of thinking to perceptual thinking as achievement of a specific goal. Reasoning, problem
it economizes efforts in understanding and problem solving and creative thinking are examples of
solving. controlled thinking.
66 Psychology for Nurses

Reasoning: It is one of the methods of finding Scientific method of problem solving:

solution to a problem. It is referred to as a highly  Problem awareness
specialized thinking involving some well orga­nized  Problem understanding
systematic steps for the mental exploration of a cause  Collection of relevant information
and effect relationship or solution of a problem.  Formulation of hypotheses or hunch for possible
Definitions: Reasoning is stepwise thinking with a solution
 Selection of a proper solution
purpose or goal in mind.
 Verification of the concluded solution or hypothesis
(Garrett—1968)
Reasoning is combining past experience in order Problem awareness: The first step in problem-solving
to solve a problem, which cannot be solved by mere behavior of an individual concerns his awareness of
reproduction of earlier solutions. the diffi­culty or problem that needs a solution.
 (Mann—1967)
Problem understanding: The difficulty or problem
Reasoning may be classified into two broad types:
™™ Inductive reasoning
experienced by the individual should be properly
™™ Deductive reasoning
identified by a careful analysis. He should be
clear about his problem. The problem then should
Inductive reasoning: In this we proceed from specific be pinpointed in terms of the specific goals and
facts or observations to general principles. Induction objectives. Thus, all the difficulties and obstacles
is a way of providing a statement or generalizing a in the path of the solution must be properly named
rule or principle that if a statement or a rule is true and identified and what is to be got through the
in one particular case, it will be true in cases, which problem-solving efforts should then be properly
appear in the same serial order and thus it may be analyzed.
applied generally to all such types of cases. For
example, iron expands when heated; water also Collection of relevant information: In this step,
expands when heated; air also expands when heated. the individual is required to collect all the relevant
Therefore, all types of matter – solid, liquid and information about the problem through all possible
gas – expand when heated. We make use of many sources. He may consult experienced persons, read
experiences and examples for arriving at a gene­ra­ the available literature, revive his old experiences,
lized principle or conclusion. think of possible solutions and put in all relevant
efforts for widening the scope of his knowledge
Deductive reasoning: Deductive reasoning is just concerning the problem in hand.
the opposite of inductive reasoning. In deductive
reasoning we proceed from general principles to Formulation of hypothesis or hunch for possible
specific situations. For example, matter expands solutions: In the light of the collected relevant
when heated; iron is a form of matter and thus information and nature of his problem, one may then
expands when heated. engage in some serious cognitive activities to think
of the various possibilities for the solution of one’s
Problem solving: Problem solving as a deliberate and problem. As a result, he may start with a few possible
serious act, involves the use of some novel methods, solutions for his problem.
higher thinking and systematic scientific steps for the
realization of the set goals. Selection of a proper solution: In this step, all
Definition: Problem solving is a process of the possible solutions, thought of in the previous
overcoming difficulties that appear to interfere step, are closely analyzed and evaluated. Gates
with the attainment of a goal. It is a procedure and others (1946) have suggested the following
of making adjustments in spite of interferences. activities in the evaluation of the assumed
(Skinner—1968) hypothesis or solution:
 Cognitive Processes 67
™™ One should determine the conclusion that days, weeks or months of concentrated effort. Failing
completely satisfies the demands of the problem. to solve the problem, the thinker turns away from it,
™™ One should find out whether the solution is either deliberately or involuntarily.
consistent with other facts and principles, which
Stage II–incubation: This stage is initiated, when
have been well established.
the creative thinker turns away from the problem.
™™ One should make a deliberate search for negative
During this stage, the ideas that were interfering
instances, which might cast doubts on the
with the solution of the problem begin to fade. The
conclusion.
unconscious thought processes involved in creative
The above suggestions can help the individual to
thinking are also at work during this stage. All this
consider a suitable solution for his problem out of the
many possible solutions. leads to the third stage.

Verification of the concluded solution or hypothesis: Stage III–insight (illumination): During this stage,
The solution arrived at or conclusion drawn must the creative thinker experiences sudden appea­rance
be further verified by applying it in the solution of of the solution to his problems, which is termed as
various similar problems and only if the derived ‘insight’.
solution helps in the solution of these problems the Stage IV–verification (evaluation): During this stage,
same may be applied. the insight is tested to see, if it satisfactorily solves
John Bransford and Barry Stein (1984) advocated the problem. If not satisfactory, the thinker is back
five steps that are basically associated with the task at the beginning of the creative process. On the
of problem solving. They referred to these steps as other hand, if the solution is satisfactory, stage V is
‘IDEAL’ thinking and arranged them in the following reached.
order: Stage V–revision: During this stage, any modi­
I — Identifying the problem. fications needed are made. The creative thinker never
D — Defining and representing the problem. considers his solution as perfect or final. It is open
E — Exploring possible strategies. for modification or revision at anytime as essential.
A — Acting on the strategies.
L — Looking back and evaluating the effects of Free Thinking
one’s activities.
In free thinking, thought processes are allowed
Creative thinking: Creative thinking is a process, in much greater freedom of action. Neither there
which the individual generates an original, unusual are any restrictions of reality in terms of time and
and productive solution to a problem. It is defined space nor any desire on the part of the thinker to
as personal, imaginative thinking which produces achieve a certain goal which is realistic. Examples
a new, novel and useful solution. Unlike ordinary of free thinking are imagination, daydreaming and
solution to problems, creative solutions are new dreaming.
ones that other people have not thought of before.  Imagination: It is a mental activity, in which we
The product of creative thinking may be a new and make use of images and also go beyond them.
unique way of conceptualizing the world around us. When we are imagining an object or situation
we do not have any sense perception of the
Stages of Creative Thinking object or situation at that time. We only have the
Stage I–preparation: The creative thinker formulates mental image of the object or the situation and
the problem and collects the facts and materials create something of our own. Thus, the object
necessary for the new solution. Very frequently, he or situation or the past experience is reorganized
finds that the problem cannot be solved inspite of and sometimes looks new and unusual.
68 Psychology for Nurses

 Daydreaming: It is a kind of idle imagination. In Level 4: Analysis

day dreamers, impossible things become possible Examining and breaking information into parts by
like our wishes, which cannot be fulfilled in identifying motives or causes; making inferences
real life are fulfilled. Daydreaming provides a and finding evidence to support generalizations.
person with an opportunity to develop his power Keywords: Analyze, categorize, compare, contrast,
of imagination and with much satisfaction and discover, dissect, divide, examine, inspect, simplify,
pleasure and provides an escape from the routine survey, take part in, test for, distinguish, list,
daily life. If we spend a major portion of our time distinction, theme, relationships, function, motive,
in daydream, we may not be able to cope with the inference, assumption, conclusion.
actual problems in real life.
 Dreaming: Dreams are mental activities of Level 5: Synthesis
lighter sleep. It is not subject to the personal and
Compiling information together in a different way by
environmental controls that operate, when we are
combining elements in a new pattern or proposing
awake. They emerge in response to some stimulus
either internal or external. In some of our dreams alternative solutions.
we solve the problems, which were perplexing us Keywords: Build, choose, combine, compile,
during our waking hours. Some dreams may be compose, construct, create, design, develop, estimate,
simple reminiscences or reproductions of what formulate, imagine, invent, make up, originate, plan,
happened during the day. predict, propose, solve, solution, suppose, discuss,
modify, change, original, improve, adapt, minimize,
maximize, delete, theorize, elaborate, test, improve,
Levels of Thinking (Based on
happen, change.
‘Bloom’s Taxonomy)

Level 1: Knowledge Elements in Development of Thought

Exhibits previously learned material by recalling
(Tools of Thinking)
facts, terms, basic concepts and answers. Images
Keywords: Who, what, when, omit, where, which,
Images, as mind pictures, consist of personal expe-
choose, find, how, define, label, show, spell, list,
riences of objects, persons or scenes once actually
match, name, relate, tell, recall, select.
seen, heard or felt. These mind pictures symbolize the
actual objects, experiences and activities. In thinking,
Level 2: Comprehension
we usually manipulate the images instead of actual
Demonstrating understanding of facts and ideas by objects, experiences or activities.
organizing, comparing, translating, interpreting,
giving descriptions and stating main ideas. Concepts
Keywords: Compare, contrast, demonstrate, Concepts are important language symbols used in
interpret, explain, extend, illustrate, infer, outline, thinking. Concepts are categorizations of objects,
relate, rephrase, translate, summarize, show, classify. events or people that share common properties. By
employing concepts, we are able to organize complex
Level 3: Application phenomena into simple phenomena. For example,
Solving problems by applying acquired knowledge, with the concept of ‘soft’ we sort out objects into soft
facts, techniques and rules in a different way. and hard. The features we select define the concept
Keywords: Apply, build, choose, construct, develop, and form the basis for making classifications. When
interview, make use of, organize, experiment with, a classification has been made, we tend to behave
plan, select, solve, utilize, model, identify. toward and think about, members of the class in
 Cognitive Processes 69
similar ways. Thus, since concepts are ways of one is stimulated to think. Reading and writing of
classifying the diverse elements in the world around the written documents and literature also helps in
us, they are convenient tools to use in thinking about stimulating and promoting our thinking process. The
the world and in solving problems. language broadens our thinking.
Steps in concept development: Brain Functions
 The first step in the development of a concept
Our mind or brain is said to be the chief instrument
is the awareness of a variety of connected
or reservoir, for carrying out the process of thinking.
experiences revealed to the individual through
Whatever is experienced through our sense organs,
perception.
carries no meaning and thus cannot serve as a
 In the second stage, comparison of these
stimulating agent unless the same is received by
experiences occurs, which highlights the essential
our brain cells and properly interpreted for driving
attributes commonly found in all these experiences.
some meaning. The mental pictures or images can be
 In the third stage, abstraction of these common
stored, formed, reconstructed or put to some use only
characteristics occurs. Abstraction is the mental
through the functioning of the brain.
step of conceiving of qualities apart from the
things, in which they are present. Then the
Errors in Thinking
abstracted common traits are verified and a name
in language is coined to represent this unity. After Our response to stimuli is determined entirely by the
this the name stands for the concept. information present in our brain at that time. When
 Language plays a significant role in the our information about the stimulus is complete
development and stability of concepts. and correct, we respond appropriately and achieve
our objective. When our information is incomplete
Uses of concepts: and/or incorrect, our response is inappropriate. An
™™ It is a time and labor saving device. inappropriate response will be called an error. All
™™ It facilitates the transfer of learning. errors in thinking occur because of incomplete or
™™ It reduces the complexity of the individual’s incorrect information about how to deal with the
world. stimuli detected.
It is necessary that we should be aware of the
Symbols and Signs errors in thinking. There are five such errors in
Symbols and signs represent and stand as substitutes for thinking:
actual objects, experiences and activities. In this sense  Partialism
they cannot be confined to words and mathematical  Adversary thinking
numerals and terms. Traffic lights, railway signals,  Time scale error
school bells, badges, songs, flags and slogans all stand  Initial judgment
for the symbolic expression. These symbols and signs  Arrogance and conceit
stimulate and economize thinking. They at once tell us,
Partialism
what to do or how to act. For example, the waving of
the green flag by the guard tells us that the train is about This error occurs when the thinker observes the
to move and we should get into the train. problem through one perspective only, i.e. the thinker
examines only one or two factors of the problem and
Languages arrives at a premature solution.

Language is the most efficient and developed Adversary Thinking

vehicle used for carrying out the process of thinking. This is like “You are wrong. So, I should be right.”
When one listens or reads or writes words, phrases type of reasoning. Politicians are the masters in this
or sentences or observes gestures in any language, type of thinking and they use it to their advantage.
70 Psychology for Nurses

Time Scale Error Favorable Elements in Development

This is a kind of partialism in thinking, in which the of Correct Thinking
thinker sees the problem from a limited time frame. Correct thinking leads to correct learning. Correct
It is similar to short-sightedness. learning leads to correct living. Every individual is
not a born thinker. He has to learn and adopt various
Initial Judgment ways of correct thinking.
Here, the thinker becomes very subjective. Instead
of considering the issue or problem objectively, the Interest and Attention
thinker approaches it with prejudice or bias.
Both interest and attention favor thinking. Attention
is difficult in the absence of interest. Without
Arrogance and Conceit
attention, thinking cannot take place.
This error is sometimes called the “Village Venus
Effect”, because like the villagers, who think that the Strong Motivation
most beautiful girl in the world is the most beautiful
girl in their village, the thinker believes that there Organized and controlled thinking needs strong
is no better solution other than that he has already motivation. The effort of the mind in thinking
found. This blocks creativity. corresponds to the strength of motivation for the solution
of the problem. Motivation maintains enthusiasm and
Cognitive Thinking Errors postpones fatigue. Necessary mobilization of energy
for thinking is made easier by motivation.
 Black and white thinking: Thinking of things in
absolute terms, like ‘always’, ‘every’ or ‘never’. Alertness and flexibility: Alertness checks mistakes
For example, if your performance falls short of and fallacies from creeping into thinking. Flexibility
perfect, you see yourself as a total failure. keeps thinking free from conservatism and blind
 Overgeneralization: Taking isolated cases and belief. Proper thinking aims at the solution of
using them to make wide generalizations. For problems and ensures there are no omissions and
example, you see a single negative event as a mistakes. This requires alertness. If one solution does
never-ending pattern of defeat: “She yelled at not serve the purpose, it is discarded and replaced by
me. She is always yelling at me. She must not another. This needs flexibility. Thus, both alertness
like me.” and flexibility serve useful purposes in thinking.
 Mental filter: Focusing exclusively on certain,
usually negative or upsetting, aspects of Flexible time limit: Rigid time schedule hampers
something, while ignoring the rest. For example, normal thinking. Inflexible and short time do not
you selectively hear the one tiny negative thing admit valid thinking.
surrounded by all the huge positive stuff. Wide range of intelligence: If a solution is to be
 Jumping to conclusions: Assuming something evolved, it is essential to keep an eye on various
negative; where there is actually no evidence to aspects of the problem and their mental relationships.
support it. This needs a developed and mature range of
 Magnification and minimization: Exaggerating intelligence.
negatives and understating positives.
 Emotional reasoning: Making decisions and Adequacy of the knowledge and experiences:
arguments based on how you feel rather than Thinking, no matter how simple or complex rests
objective reality. on the previous knowledge and experience of the
 Cognitive Processes 71
thinker. Adequacy of knowledge and experiences Adequacy of reasoning process: Logic is the science
brings adequacy in thinking. Lack of knowledge of correct reasoning, which helps to think correctly.
and experience is the common cause of erroneous Therefore, we should cultivate the habit of logical
thinking. reasoning among our children.
Thinking with a definite aim: Thinking is a purposeful Control over emotions: In emotional situations,
activity. Unless there is a definite aim or purpose, it one loses balance of mind. It is essential, to train
cannot proceed on the right track. ourselves in exercising control over our emotions.
Prejudices, super­stitions and incorrect beliefs also
Freedom and flexibility in thinking: Thinking should arrest thinking and make it biased and one-sided.
not be obstructed by imposing unnecessary restrictions Correct thinking requires elimination of all such
and narrowing of the field of thought process. Actually obstruc­ting factors.
a person should have flexible attitude towards
himself, so that he can set his thinking according Stages in Development of Thinking
to the requirements of the situation. For example,
if children are not able to solve their problems with
habitual methods, one should give them freedom to
take up new directions of thinking. They should be
allowed to form new associations and relationships.
Incubation: When one fails in solving a problem in
spite of constant and grueling work, it is suitable to
lay aside the problem for some time and relax for a
while or engage in some other activity. During this
period, the unconscious mind starts working on the
Figure 3.25: Jean Piaget formulated theory of children’s
problem and just as eggs are hatched by incubation, thinking that helped shape current ideas about develop-
a solution is evolved through the efforts of our mental psy­chology
unconscious mind. The use of the phenomenon of
Jean Piaget (1896-1980), (Figure 3.25) a Swiss
incubation is very helpful in bringing adequacy in
philosopher and psychologist, dedicated his life
the process of thinking.
work to observing and interacting with children to
Intelligence and wisdom: It is the level of intelligence, determine how their thinking processes differed
which determines our capacity for thinking. Children from adults.
with superior intelligence are able to think quickly  According to Piaget’s theory of cognitive
and sharply. Wisdom helps in thinking and getting development, the developing child passes through
an insight into the problem. Proper care should be four main discrete stages: the sensorimotor stage,
taken to use intelligence, wisdom and other similar the preoperational stage, the stage of concrete
cognitive abilities for carrying out the process of operations and the stage of formal operations.
thinking. Each stage reflects a range of organizational
patterns that occur in definite sequence and
Proper development of concepts and language: within an approximate age span.
Concepts, symbols, signs, words and language are  Development is influenced by biological
instruments of thought. Therefore proper care should maturation, social experiences and experiences
be taken to develop right concepts and linguistic with the physical environment. During cognitive
ability by using various symbols, signs and formulae development, the individual strives to find
besides words and language in the process of thinking. equilibrium between self and environment.
72 Psychology for Nurses

 Cognitive theory explains how thought processes Preoperational (2 to 7 Years)

are structured, how they developed and their During this stage sensory motor operations are
influence on behavior. Structuring of thought replaced by words and child learns language.
processes occurs through the development Applying his new knowledge of language, the child
of schema (i.e. mental images or cognitive begins to use symbols to represent objects. He is
structures). Thought processes develop through now better able to think about things and events that
assimilation and accommodation. When the are not immediately present. His thought process at
child encounters new information that is this stage usually displaces a high degree of ego-
recognized and understood within existing centricism, means an inability to take the point of
schema, assimilation of that new information view of another person, his thinking is influenced
occurs. If new information cannot be linked by fantasy—the way he would like things to be
to existing schema, the child must learn to and he assumes that others see situations from his
develop new mental images or patterns through viewpoint. He takes information and then changes it
the process of accommodation. As long as in his mind to fit his ideas. Children in this stage do
the child is able to assimilate or accommodate not understand cause-effect relationships.
adequately to new knowledge, the child is able
to achieve equilibrium or mental balance. When Concrete Operational (7 to 11 Years)
schemas are inadequate to facilitate learning,
During this stage, accommodation increases. The
disequilibrium may occur (Figure 3.26 and
child develops an ability to think abstractly and to
Table 3.4).
make rational judgments about concrete or observable
phenomena, which in the past he needed to manipulate
Sensorimotor (Birth to 2 Years)
physically to understand. During this stage children use
During this stage, the child learns about himself and logic and begin to grasp such important principles of
his environment through motor and reflex actions. nature such as number, classification and conservation
Thought derives from sensation and movement. The of mass and length. Their thought processes are limited
child learns that he is separate from his environment to concrete objects and events. Due to influence of
and that aspects of his environment—his parents or social environment, school, peers and teachers. There
favorite toy continue to exist even though they may is corresponding expansion in ways of thinking about
be outside the reach of his senses. people.

Figure 3.26: Piaget’s four stages of cognitive development

 Cognitive Processes 73
Table 3.4: Piaget’s four stages of cognitive development
Stage and age range Description
An infant progresses from reflexive, instinctual action at birth to the beginning of
Sensorimotor
symbolic thought. The infant constructs an understanding of the world by co-
(Birth to 2 years)
ordinating sensory experiences with physical actions
The child begins to represent the world with words and images; these words
Preoperational
and images reflect increased symbolic thinking and go beyond the connection of
(2 to 7 years)
sensory information and physical action
Concrete operational The child can now reason logically about concrete events and classify objects into
(7 to 11 years) different sets
Formal operational The adolescent reasons in more abstract and logical ways. Thought is more
(11 to 15 years) idealistic

Formal Operational (11 to15 Years) form of communication and recording in the
This stage brings cognition to its final form. During form of language.
this stage the person thinks in terms of abstract  The use of language, i.e. the communication of
concepts that are not physically present in nature. information through symbols arranged accor­
The child develops ability to think on scientific basis ding to systematic rules, clearly is an important
and find solutions to problems. At this point, he is cognitive ability, one that is indispensable for
capable of hypothetical and deductive reasoning. communicating with others.
 Language provides us with categories that we
Thinking in Relation to Language and use to construct our view of people and events
in the world around us. Consequently lan­guage
Communication
shapes and produces thought.
 Language is the means by which we express
our thoughts to others either in verbal or written INTELLIGENCE
forms. If we confine ourselves to perceptual or
ideational thinking that merely involves images, Intelligence is the general capacity for compre­
our thinking would remain at a relatively low hension and reasoning that manifests itself in
level. Through the use of language, we can various ways. It consists of an individual’s mental or
develop complex and abstract concepts. We learn cognitive ability, which helps the person in solving
through discussion about the essential charac­ his actual life problems and leading a happy and
teristics of concepts. well-contended life.
 Language like thought is directed to some
purpose or goal. It has a unity and orga­nization Definitions
about the goal. Words and symbols constitute the Intelligence is the aggregate or global capacity of the
stuff of the language. They have the capacity of individual to think rationally, to act pur­posefully and
freezing or enlarging our thoughts. According to deal effectively with the environ­ment.
to Piaget, language is the symbolic vehicle by (Wechsler—1944)
which thought is carried. Intelligence is the ability to master the information
 Language is extremely important in the process and skills needed to succeed within a particular
of thinking. It allows new learning to be culture. (Lolurto—1991)
communicated to others and saved for future Intelligence can be defined as a sort of mental energy,
generations. Human learning often depends upon in the form of mental or cognitive abilities available
what has been learned and saved through some with an individual, which enables him to handle his
74 Psychology for Nurses

environment in terms of adaptation to face novel Example: Leaders, ministers, salesmen, diplomats
situations as effectively as possible. are socially intelligent.
(Mangal–1993)
Abstract or General Intelligence
Classification of Intelligence
General intelligence is the ability to respond to words,
Intelligence can be divided into three kinds: numbers and letters, etc. This type of intelligence is
 Concrete intelligence acquired by study of books and related literature.
 Social intelligence Mostly good teachers, lawyers, doctors, philosophers
 Abstract or general intelligence. have this type of intelligence.

Concrete Intelligence Gardner’s Multiple Intelligence

Concrete intelligence is related to concrete materials.
According to Howard Gardner, there are eight major
This type of intelligence is applicable when the
kinds of intelligence (Table 3.5 and Figure 3.27).
individual is handling concrete objects or machines.
The person uses this intelligence in the operation
Emotional Intelligence
of tools and instruments. Example: Engineers,
mechanics generally have this type of intelligence. Intelligence that provides an understanding of
what other people are feeling and experiencing,
Social Intelligence and permits us to respond appropriately to other’s
Social intelligence is the ability of an individual to needs is called emotional intelligence. It is the basis
react to social situations in daily life. It includes the of empathy for others, self-awareness and social
ability to understand people and act wisely in human skills. High emotional intelligence might enable the
relationships. Persons having this type of intelligence, individual to tune into other’s feelings, permitting a
know the art of winning friends and influence them. high degree of responsiveness to others.

Table 3.5: Gardner’s eight major kinds of intelligence

Type of intelligence Description

1. Musical intelligence Skills in tasks involving music. Example: Musicians
2. Bodily-kinesthetic intelligence Skills in using the whole body or various portions of it, in the solution of
problems or in the construction of products. Example: Dancers, athletes,
actors, surgeons, etc.
3. Logical-mathematical intelligence Skills in problem solving and scientific thinking. Example: Scientists
4. Linguistic intelligence Skills involved in the production and use of language. Example: Literati
5. Spatial intelligence Skills involving spatial configu­rations, such as those used by artists and
architects
6. Interpersonal intelligence Skills in interacting with others, such as sensitivity to the moods,
temperaments, motivations and intentions of others
7. Intrapersonal intelligence Knowledge of the internal aspects of one self; access to one’s own
feelings and emotions
8. Naturalist intelligence Ability to identify and classify patterns in nature

Adapted from Gardner, 2000

 Cognitive Processes 75
similar environment have same level of intelligence.
This is an important fact that every nurse must un-
derstand. Because of these individual differences
some patients understand the instruc­ tions of the
nurse without much difficulty, while others cannot in
spite of their best efforts.
Genius 140 and above
Very superior 130 to 140
Superior 120 to 130
Above average 110 to 120
Average 90 to 110
Dull average 80 to 90
Borderline 70 to 80
Mild mental retardation 50 to 70
Moderate mental retardation 35 to 50
Severe mental retardation 20 to 35
Profound mental retardation 0 to 20
Figure 3.27: Gardner’s eight major kinds of intelligence
Uses of Intelligence
™™ Intelligence helps the individual to adjust to
Abilities in emotional intelligence might help to changing situations quickly and correctly.
explain why people with only moderate intelligence ™™ It helps to carry on the higher mental processes
quotient (IQ) scores can be quite successful, despite such as reasoning, judging and criticizing.
their lack of traditional intelligence. ™™ It helps to learn difficult tasks and solve problems.
™™ It helps the individual to improve performance in
Intelligence Quotient any situation.
The idea of intelligence quotient was utilized first in ™™ It helps in quick understanding of things.
1916 by Stanford-Binet tests. Intelligence quotient is ™™ It helps the individual to apply the knowledge
the ratio between mental age (MA) and chronological gained in various subjects/situations in dealing
age (CA). While the chronological age is deter­mined with present situation.
from the date of birth, mental age is determined by
intelligence tests. Theories of Intelligence
MA Factor Theories of Intelligence
IQ = × 100
CA Two-factor theory or general intelligence (G-Factor)
Imagine a 10-year-old boy scores a mental age of theory: It was advocated by Charles Spearman (1927),
12. His IQ will be a British psychologist.
MA 12 Spearman proposed a broad general intelli­gence
IQ = × 100 = × 100 = 120 factor (G) involved in every intellectual activity an
CA 10
individual undertakes. Every individual possesses
general intelligence factor (G) in varying amount.
Classification of Individuals This determines the individual’s overall ability. ‘G’ is a
According to IQ universal inborn ability. Higher the ‘G’ in an individual,
There exists a wide individual difference among greater is the success in life. In addition to the G-factor,
individuals with regard to intelligence. No two indi- there are specific abilities, which allow an individual
viduals, even the identical twins nurtured almost in to deal with particular kinds of problems. Specific
76 Psychology for Nurses

intelligence factor (S) is learned and acquired from Piaget’s theory (Jean Piaget 1970): According to
environment, it varies from activity to activity even in Piaget, intelligence is an adaptive process involving
the same individual. Examples of these specific abilities interplay of biological maturation and interaction
can be language ability, mathe­matical ability, musical with the environment. He viewed intelligence as an
or drawing skills and so on. These specific abilities may evolution of cognitive processes such as understanding
be represented as S1, S2, S3, etc. the laws of nature, principles of grammar and
Thus, an individual’s total ability or intelligence mathematical rules.
(A) is the sum of the general factor and all his specific
abilities. This can be expressed as: Bruner’s theory (Jerome bruner, 1973): According
A = G + S1 + S2 + S3 + ………. to Bruner, intelligence is a growing dependence on
internal representation of objects or situations. These
Group factor or multifactor theory: This theory was growing abilities are influenced by the environment,
expounded by L L Thurstone in 1938. Thurstone especially the rewards and punishments people
explained that certain mental operations have receive for using particular intellectual skills in
a common primary factor, which gives them particular ways.
psychological and functional unity and which
differentiates them from other mental operations. Information-Processing Theory (Robert
These mental operations constitute a group factor. Stern­berg, 1984)
So, there are a number of groups of mental abilities
and each of these groups has its own primary factor. The most recent acceptable theory of intelligence
Thurstone and his associates have identified seven has been put forward by the American psycho­
such factors. They are: logist Robert Sternberg by adopting an infor­mation
™™ Verbal factor (V): Comprehension of verbal processing approach to cognition or problem
ideas or words. solving. The information processing approach is
™™ Spatial factor (S): Ability to imagine an object the manner, in which one proceeds to perform a
in space. mental task or solve a problem from the time one
™™ Numerical factor (N): Ability to perform mathe­ comes across it, gathers information and makes use
matical calculations, rapidly and accurately. of this information for completing the task or solving
™™ Memory factor (M): Ability to memorize quickly. the problem in hand. The theory propagated by
™™ Reasoning factor (R): Ability to reason and think Sternberg identified the following steps in the way
things out. one processes information:
™™ Perceptual factor (P): Ability to perceive objects  Encoding (identifying the relevant available
accurately. information in the mind).
™™ Problem-solving factor (PS): Ability to solve  Inferring (drawing the necessary inference).
problems independently.  Mapping (establishing the relationship between a
previous situation and the present one).
Process-Oriented Theories of Intelligence  Application (applying the inferred relation­ship).
These theories have focused on intellectual pro-  Justification (justifying the analyzed solution of
cesses — the pattern of thinking that people use when the problem).
they reason and solve problems. These theorists  Responsing (providing the best possiblesolu­tion).
prefer to use the term cognitive processes in place of
intelligence. They are often more interested in how APTITUDE
people solve problems and how many get the right
solution. They have focused on the development Aptitude means quickness in learning and
of cognitive abilities. Piaget’s work is a significant understanding. It may be a natural talent or an
contribution in this area. acquired ability. It is the special aptness or fitness
 Cognitive Processes 77
for a special ability, such as mechanical, musical, ™™ Aptitude is derived from general mental ability
artistic, scholastic or religious. and it predicts one’s possible success or failure
Aptitude refers to those qualities characterizing in a vocation.
a person’s way of behavior, which serves to indicate ™™ An aptitude is an innate inborn ability to do a
how well he can learn to meet and solve a certain certain kind of work. Aptitudes may be physical
specific kind of problem. People differ in terms of or mental. Many of them have been identified
performance and human activity like leadership, and are testable.
music, art, teaching, etc. Individuals possess certain ™™ Aptitude helps an individual to learn faster and
specific aptitude or ability in addition to intellectual achieve success.
abilities or intelligence, which helps them to achieve ™™ Aptitude is very helpful in choosing any kind
success in some specific occupations or activities. of activity, in which we wish to be successful
Thus aptitude means specific ability or capacity or enjoy. For example, if you have an aptitude
distinct from general intellectual ability that helps in dance, you would enjoy and be successful in
to acquire proficiency or achievement in a specific dance training, if you do not have this aptitude,
field. you would never enjoy nor progress in dance
even if you took a great deal of training. Doing
Definitions things in which you have an aptitude will protect
you from frustrations and failures and help you
Aptitude is variously defined as innate learning
to adjust and be successful much more quickly.
ability, the specific ability needed to facilitate
™™ To predict an achievement in some particular job
learning a job, aptness, knack, suitability, readiness,
or training courses we need to know more about
tendency, natural or acquired disposition or capacity
one’s aptitudes rather than his intelligence or
for a particular activity or innate component of a
general ability.
competency.
™™ Aptitude is a special ability, where as intelligence
Aptitude refers to those qualities characterizing is a general ability. With the knowledge of
a person’s way of behavior, which serve to indicate intelligence of an individual we can predict
how well he can learn to meet and solve a certain his success in a number of situations involving
specified kinds of problem. (Bingham—1937) mental function or activity. The knowledge of
An aptitude is a combination of characteristics aptitude on the other hand acquaints us with the
indicative of an individual’s capacity to acquire specific abilities and capabilities of an individual
(with training) some specific knowledge, skill or set to succeed in a particular field of activity.
of organized responses, such as the ability to speak ™™ Aptitude differs from ability and achievement, in
a language, to become a musician, to do mechanical that it is forward looking in nature, i.e. it gives an
work. (Freeman—1971) indication of the future success of an individual,
where as ability limits itself to the present
Concepts performance of an individual. Achievement, with
™™ An aptitude is an innate component of a competency its past oriented nature merely indicates what
to do a certain kind of work at a certain level. an individual has learned or acquired. Aptitude
Aptitudes may be physical or mental. Aptitude is should not be confused with interest. One may
not knowledge, understanding, learned or acquired show interest in a particular act or job, but may or
abilities (skills) or attitude. The innate nature may not have the aptitude for it. The opposite is
of aptitude is in contrast to achievement, which also true. However, to achieve the desired success
represents knowledge or ability that is gained. in a given task, one must have both interest as
™™ Aptitudes are latent potentialities. Given oppor- well as aptitude. Interest usually grows with
tunities for development, would result in great knowledge. For example, if you have an interest
achievement. in something, you will learn more about it. As
78 Psychology for Nurses

you learn more about that, your interest in it will Individual Differences and
grow. The interest in nursing will grow as you Variability in Aptitude
progress in the nursing education.
Suppose that two persons of equal intelligence have
™™ Aptitude is different from skill and proficiency.
the same opportunities to learn a job or develop a skill
Skill is the ability to perform a given act with
they attend the same on the job training or classes,
ease and precision. For example, we may say that
study the same material and practice the same length
a person is skilled in carpentry or playing piano.
of time. One of them acquires the knowledge or skill
Skill refers to psychomotor ability. Proficiency
has much the same meaning, except that it is more easily; the other has difficulty and takes more time,
comprehensive. It includes not only skills in certain if they ever master the skill. These two people differ
types of motor and manual activities, but also in in aptitude for this type of work or skill acquisition.
other types of activities as shown by the extent of Aptitudes are highly individualized and
one’s competence in language, book-keeping, etc. specialized apart from one’s general level of
intelligence. For example, two individuals may have
Types same level of intelligence, but not do well in the same
kind of education or training, because of differences in
Manual aptitude: It indicates motor abilities or skills aptitude. Differences in aptitude will decide the area,
required for semi-skilled occupations. in which they will practice successfully. One nurse
Mechanical aptitude: This aptitude involves the may have an aptitude for handling surgical instruments
ability to understand and solve problems involving and do well in the operation theater; another may have
mechanical relationships and arrangements such an aptitude for problem solving in research and enjoy
as those, which occur in the adjustment, repair and research and teaching. Aptitudes are very important in
assem­bly of machinery. determining success in professional practices.
Clerical aptitude: This aptitude indicates different An aptitude is a composite of different
abilities like perceptual, intellectual abilities, mental component abilities that together make for success
skills and motor skills. in performance in a particular field. The higher the
Other types of aptitude: are musical, graphic, aptitude, the higher the chances of success. The
scholastic/professional aptitudes. lower the aptitude, the lower the probability of
Commonly recognized aptitudes that are testable achievement. The higher the aptitude, the less the
include: time required for learning and mastery. The lower
™™ General learning ability the aptitude, the more the time required for learning.
™™ Verbal aptitude
™™ Numerical aptitude Psychometric Assessment of
™™ Inductive reasoning aptitude, also called differ-
Cognitive Process
entiation or inductive learning ability
™™ Finger dexterity aptitude Neuropsychological testing is a procedure that
™™ Number series aptitude measures and identifies cognitive impairment and
™™ Language learning aptitude functioning in individuals. Neuropsychological
™™ Mechanical comprehension testing provides diagnostic clarification and grading
™™ Symbolic reasoning aptitude, also called analyti- of clinical severity for patients with subtle or obvious
cal reasoning cognitive disorders. These include:
™™ Visual memory ™™ Children who are not achieving appropriate
™™ Visual pursuit, also called line tracing developmental milestones.
 Cognitive Processes 79
™™ Infants exposed to drugs, alcohol or illness in- completion, block design, etc.) with minimum use
utero. of paper and pencil. Instructions are generally given
™™ Patients with head injuries. by demonstrations and gestures. These tests are
™™ Patients with Parkinson disease or other neuro- used in infants, mentally retarded, foreigners and
logical diseases. those who do not understand language, in which the
™™ Patients exposed to chemicals or toxins. tests are conducted. Example: Bhatia’s Battery of
™™ Substance abusing patients. performance test.
™™ Stroke victims.
™™ Patients with dementia. Group Verbal Intelligence Tests
Neurological tests for assessing various cognitive These tests use language and are applied to a group
processes are as below (Table 3.6): of individuals at a time. For example, Army Alpha
Test, Army General Classification Test.
Assessment of Intelligence
Intelligence can be assessed through psycho­ Group Non-verbal Intelligence Tests
logical tests. Alfred Binet (1875-1911) was the These tests do not necessitate the use of language
first psychologist to device an intelligence test. and are applicable to the group of individuals at a
Intelligence tests can be classified into two broad time. In these tests, material does not contain words
categories namely (Figure 3.28). or numerical figures. It contains pictures, diagrams
 Individual test and geometrical figures, etc. printed in a booklet. The
 Group test subject is required to do such activities as to fill in
some empty spaces, draw some simple figures, point
Individual Verbal Tests out similarities and dissimilarities, etc. For example:
These tests only test one individual at a time. These Army Beta Test, Raven’s Progressive Matrices Test.
tests make use of language. For example, Stanford-
Binet scale. Comparison between individual and group tests:
Comparison of both individual and group test for
Individual Performance Tests intelligence is given in Table 3.7.
The complete non-verbal or non-language tests of
Uses of Intelligence Tests
intelligence for testing an individual at a time, fall
into this category. These tests involve the mani­ ™™ Intelligence testing is used to predict how well a
pulation of objects (e.g. picture arrangement, picture person will learn in a program of study.

Figure 3.28: Classification of intelligence tests

80 Psychology for Nurses

Table 3.6: Neurological tests for assessing various cognitive processes

Domain Neurological test

– Wechsler Scales
– Wechsler Adult Intelligence Scale-Revised (WAIS-R)
Intellectual functioning – Wechsler Adult Intelligence Scale-III (WAIS-III)
– Wechsler Intelligence Scale for Children-IV (WISC-IV)
– Stanford-Binet Intelligence Scale-IV

– Wechsler Individual Achievement Test (WIAT)

Academic achievement
– Woodcock-Johnson Achievement Test

– Multilingual Aphasia Examination

Language processing – Boston Diagnostic Aphasia Examination
– Token Test
– WAIS Block Design Subtest
Visuo-spatial processing – Judgment of Line Orientation
– Hooper Visual Organization Test

– Digit Span Forward and Reversed

Attention/ concentration
– Cancellation Tasks (letter and symbol)

– Wechsler Memory Scale (WMS)

– Logical Memory I and II - Contextualized prose
Verbal learning and memory
– Verbal Paired-Associates
– WMS-III Verbal Memory Index
– Visual Reproduction I and II
– Non-verbal Selective Reminding Test
Visual learning and memory
– Continuous Recognition Memory Test
– Visuo-Motor Integration Test - Block design

– Wisconsin Card Sorting Test

Executive functions
– WAIS Subtests of Similarities and Block Design

– Simple and Choice Reaction Time

Speed of processing
– Symbol Digit Modalities Test—written and oral

– Halstead-Reitan Neuropsychological Battery (HRNB)

Sensory-perceptual functions
– Actual Performance Test and Sensory Perceptual Examination

Motor speed and strength – Index Finger Tapping

– Rey 15 Item Test
Motivation – Dot Counting
– Forced-Choice Symptom Validity Testing
– Minnesota Multiphasic Personality Inventory (MMPI)
– Beck Depression Inventory (BDI)
Personality assessment
– Rorschach Test
– Thematic Apperception Test for Children or Adults
 Cognitive Processes 81
Table 3.7: Comparison between individual and group tests

Individual tests Group tests

1. They test one individual at a time. Hence, they 1. A group of children can be tested at the same time,
are not economical in terms of time, labor and hence economical
money
2. These are applicable both for children and 2. These tests cannot be administered to young children
adults below the age of 10 years
3. These bring the tester and child closer and 3. Personal contact bet­ween the two is not possible
establish a better relationship bet­ween the two

™™ They help classify students so that the teacher timed sub tests. Results are compared to age-group
knows the capacity of each student to learn. norms or other criteria as opposed to self-report
™™ They help to separate the slow learner from the inventories of abilities often found in computerized
gifted learner so that special methods can be career exploration systems. For helping a person,
adopted for training these two different groups. find and pursue a career, course of study or work
™™ They are used in selection for admission into experience program, aptitude assessment should
different courses of study and for awarding logically precede achievement testing or skills
scholarships and vocational guidance. assessment.
™™ They are used in selection of candidates for Aptitude tests measure the degree or level of
different jobs. one’s special flair. They are chiefly used to estimate
™™ Intelligence tests are also useful in child guidance. the extent to which an individual would profit from a
With their help, we can discover the children’s
specific course or training or to predict the quality of
backwardness in studies or other educational
his or her achievement in a given situation.
difficulties.
For example, mechanical aptitude test mea­
sures a person’s aptitude for mechanical work;
Limitations of Intelligence Tests clerical aptitude tests are employed for measuring
 They cannot measure intelligence with mathe­ the aptitude for clerical work; musical aptitude tests
matical accuracy. Nor can they predict with measure the musical talent, etc.
absolute certainty success in school or in a
profession. Aptitude Test Types
 They do not throw any light on the character,
morals, emotions or temperament of the  Verbal reasoning
individual, the understanding of which is so  Numerical reasoning
essential in understanding one’s personality.  Abstract/inductive/diagrammatic reasoning
 Logical reasoning
Measurement of Aptitude  Specialty/technical/information technology (IT)
Aptitude assessments are used to predict success or
failure in an activity. For vocational/career guidance Verbal Reasoning
and planning they are used to measure different A verbal reasoning test is an aptitude test that meas-
aptitudes such as general learning ability, numerical ures the ability to comprehend complex written
ability, verbal ability, spatial perception and clerical materials and deduct relevant information and con-
perception. Objective aptitude tests are based on clusions. Verbal reasoning tests also include spelling,
82 Psychology for Nurses

grammar, logic and vocabulary tests. Different apti- ™™ O’Connor Finger Dexterity and
tude tests are administered to candidates in different ™™ Tweezer Dexterity tests
professions. Mechanical aptitude: It covers a variety of factors
such as spatial visualization, perceptual speed,
Numerical Reasoning mechanical information and manual dexterity. This
A numerical reasoning test includes a wide range aptitude involves the ability to understand and
of aptitude tests varying from ‘basic arithmetic solve problems involving mechanical relation­­­­ships
tests’ through ‘estimation tests’ that measure speed and arrangements such as those which occur in the
in making educated mathematical estimations to adjustment, repair and assem­bly of machinery. Some
‘advanced numerical reasoning tests’ that measure of the well known mechanical aptitude tests are:
ability to interpret complex data presented in various ™™ Minnesota mechanical assembly test
graphic forms and to deduce information and ™™ Minnesota spatial relations test
conclusions. ™™ A battery of mechanical aptitude tests
™™ Bennett tests of mechanical comprehension
Abstract/Inductive/Diagrammatic Reasoning
Clerical aptitude: This aptitude indicates different
These aptitude tests measure logical reasoning and abilities like perceptual, intellectual abilities, mental
perceptual reasoning skills. These aptitude tests do skills and motor skills. Some of the popular clerical
not rely on acquired linguistic or numeric abilities, aptitude tests are:
but on innate abilities and are thus called non-verbal ™™ Detroit clerical aptitude examination
reasoning tests. ™™ Minnesota vocational test for clerical workers.
Standardized aptitude tests are also available
Logical Reasoning for the measurement of scholastic and professional
The logical reasoning test is an aptitude test meant aptitudes [scholastic aptitude tests (SAT)] of
to assess the ability to understand and make individuals for the specific courses or professions like
comprehensive conclusions from the provided data. Engineering, Medicine, Law, Business Management,
It is one of the most common aptitude tests and Teaching, etc.
although it may seem as one of the most difficult, Instead of employing specialized aptitude tests
with practice it becomes much simpler than it seems for measuring specific aptitudes, the present trend
to be at first. is to use multiple aptitude test, batteries to assess
the suitability of persons for different professions
Specialty/Technical/IT on the basis of scores in the relevant aptitude tests.
Certain sectors and positions require an aptitude Like intelligent tests, multiple aptitude test, batteries
test that measures specific skills related to certain measure a number of abilities. For example, while
positions. For example, there is a wide variety of general aptitude test battery (GATB)—measures the
niche aptitude tests for IT personnel and for clerical verbal aptitude, numerical aptitude, spatial aptitude,
positions. These tests are administered in addition to clerical perception and mortar coordination,
the main aptitude tests. differential aptitude test (DAT)–measures verbal
Other types of aptitude tests are: mechanical reasoning, numerical ability, abstract reasoning,
aptitude test, musical aptitude test, art judgment test, spatial relation, mechanical reasoning, clerical
professional aptitude test, scholastic aptitude test, ability and linguistic ability.
clerical aptitude test. Aptitude tests have a wide range of application.
They have proven to be the backbone of all kinds
Manual aptitude: It indicates motor abilities or skills of guidance services and selection programs as
required for semi-skilled occupations. Two tests, they are very useful for predicting the suitability of
which will measure manual aptitude are: individuals for specific jobs and lines of work.
 Cognitive Processes 83

ALTERATIONS IN COGNITIVE to be of different sizes because of the size of the

PROCESSES surrounding objects (Figure 3.29).
Illusion of length: In Muller-Lyer Illusion,
Alterations in Attention the line segments of the same size appear to be of
Normal people typically pays selective attention different lengths based on the shapes that are placed
to one message, screening out the stream of other at the ends (Figure 3.30).
distracting stimuli and thoughts. For example, now Horizontal vertical illusion: In this, there are
when you are reading you can ignore the noise and two straight lines, one horizontal and the other
the visual clutter that could divert you from your goal vertical. Both are equal in length, but invariably the
of completing this sentence. However, people with vertical one is perceived to be longer than the other
schizophrenia and attention deficit hyperactivity (Figure 3.31).
disorder (ADHD) are easily distracted. All these examples are optical illusions. Illusions
Attention deficit hyperactivity disorder is a arise either because of the ambiguous qualities
disorder marked by inattention, impulsiveness, a of what is perceived or the state of the perceiving
low tolerance for frustration and generally a great person or both.
deal of inappropriate activity. ADHD children have
difficulty in sustaining attention, are distractible and Alterations in Learning
often fail to follow instructions. Learning disorders are academic difficulties
experienced by children and adults of average to
Alterations in Perception above average intelligence. People with learning
Sensory information received by our sensory
receptors is interpreted and given some meaning
through the process of perception. Sometimes
this interpretation goes wrong, so the resulting
perception fails to correspond with reality. Such false
perceptions are called perceptual illusions.

Types of Illusions
Illusion of size: This type of illusion provides
false perception of the size of the objects. A larger
background always makes the objects look smaller in
comparison to a smaller background, where they will
be perceived as larger. For example, in Ebbinghaus Figure 3.30: Illusion of length
illusion, two circles of the same size are perceived

Figure 3.29: Illusion of size Figure 3.31: Illusion of horizontal vertical illusion
84 Psychology for Nurses

disorders have difficulty with reading, writing, Alterations in Memory

mathematics or a combination of the three. These Memory can be defined as an organism’s ability to
difficulties significantly interfere with academic encode, retain and recall information. Alterations in
achievement or daily living. memory can range from mild to severe, yet are all
Learning disorders are thought to be caused by a result of damage to neuroanatomical structures;
neurological abnormalities that trigger impairments either in part or in full. This damage hinders the
in the regions of the brain that control visual and storage, retention and recollection of memories. The
language processing, attention and planning. These common memory disorders are presented below:
traits may be genetically linked. Children from
families with a history of learning disorders are more Agnosia is the inability to recognize certain objects,
likely to develop disorders themselves. Learning persons or sounds. Examples of specific types of
difficulties may also be caused by such medical agnosia include: visual agnosia, auditory agnosia,
conditions as a traumatic brain injury or brain prosopagnosia, somatosensory agnosia, apraxia,
infections such as encephalitis or meningitis. The associative agnosia, etc.
three main types of learning disorders are reading Alzheimer’s disease is a progressive, degenerative
disorders, mathematics disorders, and disorders of and fatal brain disease, in which cell to cell
written expression. connections in the brain are lost. As a result, the
death of brain cells occur leading to severe cognitive
Reading Disorders
impairment.
Children with reading disorders have difficulty in
recognizing and interpreting letters and words Amnesia is an abnormal mental state, in which
(dyslexia). They are unable to recognize and decode memory and learning are affected out of all
the sounds and syllables (phonetic structure) behind proportion to other cognitive functions. The two
written words and language in general. This condition forms of amnesia are anterograde amnesia and
lowers accuracy and comprehension in reading. retrograde amnesia.
Dementia refers to a large class of disorders charac-
Mathematics Disorders terized by the progressive deterioration of thinking
Children with mathematics disorders (dyscalculia) ability and memory as the brain becomes damaged.
have problems recognizing and counting numbers
correctly. They have difficulty using numbers in Hyperthymestic syndrome causes an individual
everyday settings. Mathematics disorders are typically to have an extremely detailed autobiographical
diagnosed in the first few years of elementary memory. Patients with this disorder are able to recall
school when formal teaching of numbers and basic events from everyday of their lives. This disorder is
mathematic concepts begins. very rare with only a few confirmed cases.
Wernicke-Korsakoff syndrome is a severe neurological
Disorders of Written Expression disorder caused by thiamine (vitamin B1) deficiency
Disorders of written expression typically occur in and is usually associated with chronic excessive alcohol
combination with reading disorders or mathematics consumption. Symptoms of Wernicke-Korsakoff
disorders or both. The condition is characterized by syndrome (WKS) include confusion, amnesia and
difficulty with written compositions (dysgraphia). impaired short-term memory. It also tends to impair
Children with this type of learning disorder have the person’s ability to learn new information or tasks.
problems with spelling, punctuation, grammar and In addition, individuals often appear apathetic and
organizing their thoughts in writing. inattentive and some may experience agitation.
 Cognitive Processes 85
Alterations in Thinking Adaptation skills are those behaviors, by which
an individual makes adjustments and indepen­
Cognitive disorders are mental conditions that
dent living in the society. In childhood, these are
cause people to have difficulty thinking clearly
the self-help activities such as eating and dressing
and precisely. Although symptoms of cognitive
independently. Later on the adaptive behaviors
disorders vary, they are generally marked by are concerned with basic academic skills and
impaired awareness, perception, reasoning, memory coping skills such as telling time, using money
and judgment. A wide variety of factors can lead and assuming social responsibilities. Slowness in
to cognitive disorders, including general medical intellectual development may be widespread and
conditions, brain infections and head injury. The four affect all aspects of cognition. Mental subnormality is
major categories of cognitive disorders are: categorized into four levels—mild, moderate, severe
 Delirium: A change in consciousness that develops and profound. Only the extre­mely retarded must be
over a short period of time, in which people have institutionalized. Others can be educated at a slower
a reduced awareness of their environment. pace and trained for work and self-maintenance.
 Dementia: A progressive deterioration of brain Only 25 percent of mental retardation is caused
function that is marked by impairment of by physical disorders. Other causes are unknown.
memory, confusion and inability to concentrate. Physical disorders include fetal birth injuries,
 Amnesia: A significant loss of the memory, damage, genetic abnormalities and metabolic
despite, no loss of other cognitive functions like disorders. These are phenyl­ketonuria, microcephaly,
in dementia. hydrocephaly, cretinism and Down syndrome.
 Cognitive disorders not otherwise specified:
Cognitive impairment presumed to be due to a Mentally Gifted Children
general medical condition or substance use and These are the individuals with IQs of 140 or higher.
does not fit into the other categories. In the early childhood, a gifted child is generally
found to be a misfit in his class, because the level
Alterations in Intelligence of teaching in normal class room is for an average
child, where as the gifted child is able to compre­hend
People differ in intellectual ability and capacities
much faster. As a consequence they often indulge in
like reasoning and thinking, power of imagination,
behavioral irregularities. They have been found to
creative expression, concentration, etc. Intelligence
be gross underachievers and extremely unhappy.
level differs from individual to individual. We can
One problem seems to be that such extremely bright
classify the individuals from super normal (IQ above
children find themselves intellectually misfit with
120) to idiots (IQ from 0 to 50) on the basis of their
children of their own age and physically misfit with
intelligence level.
the older people who are their intellectual equals.
But things improve by adulthood and they appear
Mental Subnormality
to be happier and better adjusted than most others
Mental subnormality refers to sub-average of their age. With the right type of training, their
intellectual functioning, which originates in the superior potential is channelized in constructive task.
developmental period and is associated with The most common mental disorders that affect
impairment in adaptive behavior. A person is cognitive functions; mainly memory processing,
regarded as mentally subnormal if: perception and problem solving are amnesia,
™™ IQ attained is below 70 on standard psychological dementia and delirium. Others include anxiety
tests of intelligence; disorders such as phobias, panic disorders, obsessive-
™™ Their adaptive skills are inadequate to cope up compulsive disorder, generalized anxiety disorder
with the daily routines. and post-traumatic stress disorder. Mood disorders
86 Psychology for Nurses

such as depression and bipolar disorder are also ™™ Accurate perception, and observation will help
cognitive mental disorders. Psychotic disorders such the nurse to gather accurate information and
as schizophrenia and delusional disorder are also knowledge, which will help the nurse to learn
classified as cognitive mental disorders. more easily, adjust more quickly to new situa­
Cognitive disorders affect thinking and percep- tions. It also prevents accidents and incidents
tual processes and the acquisition of knowledge harmful to the patient.
and new information. Cognitive disorders have an ™™ With accurate perception, nurses memory im-
enormous social impact, because special educational proves, recording and reporting is more accurate
resources are required and independent living often and is helpful for the patient and other health,
cannot be achieved. Learning problems may lead to team members.
behavioral disorders in the home and community. ™™ All types of false perceptions, illusions should be
Severe cognitive impairment is usually accompanied scrupulously avoided by nurse.
by physical abnormalities.
Nursing Implications of Learning
APPLICATIONS IN NURSING
™™ Learning is fundamental to the development and
PROFESSION
modification of behavior, thus knowledge of the
Nursing Implications of Attention learning process may be usefully applied to many
clinical situations and academic work.
™™ Attention helps in bringing mental alertness and
™™ Many of our subjective feelings, emotions and
preparedness. As a result the nurse becomes
attitudes are probably conditioned responses.
mentally alert and tries to exercise one’s mental
powers as effectively as possible for providing care. Through generalization, it becomes difficult to
™™ Attention helps the nurse to concentrate by identify the origin of our emotional responses.
focusing consciousness on one object at a time Both our adaptive emotional responses as well
rather than two. as maladaptive responses are learned and can be
™™ Attention helps the nurse for better organi­zation unlearned through principle of learning.
of the perceptual field for maximum clarity and ™™ Learning methods have wide applications in
understanding of the patient condition. educational setting. In programmed learning, the
™™ Attention provides strength and ability to material to be learned is broken up into small
continue the task of cognitive functioning, easy steps, so that the learner can accomplish
despite the obstacles laid by the distractions. without frustrations. Also with programmed
™™ The nurse can use psychology of attention for learning, learner can master the task at his own
invoking not only voluntary, but also involun­tary pace; with versatile and flexible learning, the
attention to her job. learner can improve learning style.
™™ Applications of reinforcement principles can
Nursing Implications of Perception often increase productivity, both in studies as
™™ Accurate perception and observation are very well as in vocation.
important for a nurse to provide quality care to ™™ A nurse should understand the nature of learning
a patient. All nursing activities require accurate and the factors that which will affect learning. As
observation and perception. For example, check- learning modifies our behavior, it is necessary
ing vital signs, assessing patient, administering for a nurse to learn only the right things, so that
medications, etc. modification takes place in the right direction.
™™ If nurse is not a keen observer, nurse will not ™™ Nurse must have a well-defined purpose and goal
be able to note some very critical or important in all learning situations.
symptoms with the result that sometimes the ™™ Nurse should always connect the new material
patient may die premature. with the old material.
 Cognitive Processes 87
™™ Repeated practice is more important for effective thing to do is to review early and often. Periodical
learning. Modern nursing requires skills in review will help retention of the material learnt.
many complicated techniques. In order that ™™ Meaningful material is not only more easily
these skills are learned profi­ciently, the nurse learnt than non-sense material, but it is also
will need repeated day-to-day practice. Besides remembered longer and more fully.
practice the nurse needs to observe attentively ™™ Give some short rest pauses between study
the demonstrated techni­ques, to understand the times. It would help to consolidate the learned
instructions given by the teacher and make use of material. Periods of rest and preferably sleep
her intelligence, thinking and memory. help retention.
™™ Over learning aids retention.
Nursing Implications of Memory ™™ Very often forgetting can occurs, because of
The following are the tips to improve memory interference. Teachers should normally avoid
retention: presenting ideas, which might easily be confused
™™ Learning needs a desire, a receptive mood and
in close succession.
interest in the learning task before any success ™™ Review before examination.
can be anticipated.
Nursing Interventions for Impaired Memory
™™ Things are better remembered when presented
through more than one sense. Materials when ™™ Encourage the patient to use written cues such as
seen and heard are better retained than the ones, calendar lists or a notebook. These cues decrease
which are only seen or heard. Use imagery the patients need to recall appoint­ments, activities
to visualize the material and give auditory and so on without assistance.
stimulation by reading aloud. For example, while ™™ Provide single step instructions for the patient,
studying nervous system, visualize the structure because patient with memory impairment cannot
of nervous system and also read loudly. remember multistep instructions.
™™ Develop as many associations as possible ™™ Keep environmental changes to a necessary
between the material presented and the one minimum.
already learnt. A child for example, learns the ™™ It is important to maximize independent function
alphabets easily through associations such as: A and to unobtrusively assist the patient when
for ‘apple’, etc. memory function has deterio­rated further.
™™ Rhythm is an aid to learning. Children learn ™™ It is important to preserve the patient’s dignity
nursery rhymes easily, because of the rhythm. and minimize his frustration with progressive
™™ Distribute learning as much as possible. Stu­ memory loss.
dying in smaller units, but over a longer period
stays longer than crammed up material. Nursing Implications of Thinking
™™ Rehearsal and recitation are useful in memo­ Correct thinking is one of the greatest assets for a
rizing. Recitation gives us a chance for self- nurse. Certain recommendations for student nurses
evaluation and builds confidence in oneself. in order to think correctly and reason out properly
Elaborative rehearsal is more effective than are as under:
maintenance rehearsal.  The nurse should meet problems directly instead
™™ Retention occurs better if, an attempt is made at of evading them or shifting respon­ sibility to
having a general look at the entire material even another person. She should look for the central
before intensive study is taken up. Going over problem.
the whole unit gives the general picture before it  The job of a nurse requires a lot of thinking. The
is broken into units. knowledge of psychology of thinking as well as
™™ Since, forgetting is much faster during the period the technique is therefore very much helpful to
immediately following learning, the obvious the nurse. The nurse uses thinking to understand
88 Psychology for Nurses

rationale behind each proce­ dure. In order to  Nurse’s explanations or guidance to the patient
think correctly, a nurse should have adequate would be according to the patient’s intellectual
knowledge and experience. She should be able to level.
distinguish between facts and opinion.  As a student and later as a teacher, the know­ledge
 Logical thinking helps to think correctly. Hence, she of intellectual function is useful for a nurse.
should develop the habit of thinking scientifically. Teaching method, content of the subject matter
 Nurse should be able to size up the whole and expectations from students should be based
situation. A nurse should try to think on definite on student’s intellectual functioning.
lines with a definite purpose. Unless there is a  Knowledge regarding intelligence helps the
definite aim or purpose thinking cannot proceed nurse in diagnosing a patient with mental sub-
on the right track. normality or with very superior intelligence.
 Nurses with past experiences or habitual methods  In diseases related to neuropsychiatric disorders,
do not help in solving problems; she should epilepsy, psychiatric disorders and some of the
strive for new associations, relation­ships and endocrinal disorders, assessment of intelligence
possibilities for arriving at satis­factory results. is of great assistance in their management.
 She should form the habit of looking for  Knowledge about abnormalities in newborns and
relationships and generalizing from facts. development of their intelligence helps the nurse
 She should cultivate the right habits of in providing suitable care.
observation and attention for collection of factual  Aging patients though physically slow, retain
data, on which the thinking can be based. their levels of intelligence. Respect and
 A nurse should also adopt a flexible attitude encouragement with combined nursing care has
towards patient’s problems. to be ensured.
 Nurse’s emotions should not control the reason. Every individual is unique, especially when
Also moods, attitudes or behavior of the patients intelligence is the judging factor. A nurse in the
should not interfere with her scientific thoughts course of discharging the duties has to heavily rely
and ideas with regard to treatment. Nurse should on verbal and non-verbal communication patterns.
avoid prejudice and look for a new meaning. Nurse may have to interact with the patient, patient’s
 Muscular responses should be recognized as family members, explain and clarify proce­dures and
an important part of thinking. It is possible to medications. The intelligence level of the patient and
recognize muscular tensions in oneself and others family members decides how effectively the nurse
when thinking deeply. Some muscle tension may is able to communicate and discharge her duties.
be exhibited by the patient using body language, Lower the levels of intelli­gence, more the time and
which needs to be observed and understood by patience, the nurse will have to invest in caring for
the nurse. the patient. The instructions may have to be simple
⓫ It is an error to assume that a person cannot think and repeated more often. However, where the patient
when paralyzed or seriously ill. is more intelligent he can be expected to take an
⓬ In the midst of all the superstitions and contrary active part in his own health care in the future.
beliefs of patients, the nurse must always insist
upon what is factual, rational and helpful to the Nursing Implications of Aptitude
patient.  Knowledge of the aptitudes, their measurements
and conditions will be helpful to the nurse to
Nursing Implications of Intelligence develop a proper aptitude for her profession and
 Knowledge about the nature of intelligence to guide those around her in entering professions
and its measurement is useful to the nurse in according to their aptitudes.
understanding herself, her colleagues as well as  The knowledge of the aptitude will also give her
her patients. optimism in her own future success.
 Cognitive Processes 89
 If nurse has an aptitude for her profession she 7. Discuss the salient features of sensation and
is bound to be a successful nurse, whatever the perception. (Apr 2006)
impediments she might meet in her path. 8. Can attention be divided? Explain. (2004)
9. Define perception. What are the factors affecting
perception? (2004)
REVIEW QUESTIONS 10. Explain the factors affecting sensation and
perception. (2004)
Attention 11. Briefly discuss the objective conditions of attention.
(Nov 2003)
Short Essay 12. Enumerate and explain determinants of attention.
1. Explain factors influencing attention. (Mar 2012) (April 2003)
13. Describe the principles of perceptual organization.
Short Answers (Sep 2011)
14. Organization of perception. (Mar 2011, Mar 2009)
1. Attention. (Mar 2012)
15. Characteristics of perception. (Aug 2010, Sep 2009)
2. Varieties of attention. (Sep 2011)
16. Errors of perception. (Mar 2009)
3. Fluctuation of attention. (April 2008, May 2007)
17. Explain factors influencing perception. (Mar 2009)
4. Sensation and perception. (April 2008, 2004)
5. Distraction of attention. (Oct 2007)
6. Sensation. (Oct 2007, 2004, Aug 2010) Short Answers
7. List the determinants of attention. (April 2006) 1. Illusions. (Mar 2012, Sept 2011, Aug 2010, Sep
8. Division of attention. (Mar 2009, April 2005) 2011, Mar 2009)
9. Extra sensory perception. (April 2005) 2. Perception. (Mar 2012)
10. What are common errors in perception? (2004) 3. Law of Proximity. (Mar 2011)
11. What are ‘illusions’? (2004) 4. Sensation. (Aug 2010)
12. Span of attention. (Nov 2003) 5. Division of attention. (Mar 2009)
6. Errors in perception. (Mar 2009)
PERCEPTION 7. Meaning of perception. (Mar 2009, Sep 2009)

Long Essays LEARNING

1. Define perception and discuss the organi­zation of
perception. (Oct 2007) Long Essays
2. What are the factors influencing perception and what
1. Define learning. Explain operant conditioning given
is the relation between sensation and perception?
by skinner. (Sep 2009)
(April 2005)
2. Define Learning. Explain the Psychic secretion and
3. Describe sensory disorders and explain nursing
the operant conditioning. (Mar 2009)
implications for sensory abnor­malities.
3. What is transfer of training? Discuss the theories of
transfer. (Apr 2008, May 2007)
Short Essays 4. Discuss the laws of learning. Explain the role of
1. Organization of perception. (Mar 2012) motivation and anxiety on learning process.
2. What are errors in perception? Write the diffe­rences. (Oct 2006)
(May 2007) 5. Define learning. Describe learning by condi­
3. Varieties of attention. (May 2007) tioning and its educational implication in nursing.
4. Factors influencing perception. (Oct 2006) (Apr 2006)
5. Describe the factors that control and direct attention. 6. Explain the laws of learning and what are the factors
(Oct 2006) influencing our memory. (April 2005)
6. Write the difference between sensation and 7. Define learning. What are the laws of learning?
perception. (Apr 2006) Explain the different types of learning quoting
studies wherever necessary. (2004)
90 Psychology for Nurses

Short Essays 3. Define learning and explain efficient methods of

1. Explain the various types of learning. (Mar 2012) memorizing. (Apr 2008)
2. Classical conditioning. (Mar 2012, Mar 2011)
3. Difference between learning by classical Short Essays
conditioning and operant conditioning. (Sept 2011) 1. List factors influencing forgetting. (Mar 2012)
4. Explain trial and error method of learning. (Sep 2. Differentiate between long term and short term
2011, Mar 2009) memory. (Sep 2011)
5. Transfer of learning. (Aug 2010, Sep 2009) 3. Theories of forgetting. (Mar 2011, Mar 2009)
6. Techniques of learning. (Mar 2009) 4. Causes of Forgetting. (Mar 2012, Aug 2010)
7. Describe the laws of learning and their educational 5. What is forgetting? How can it be minimized?
implications. (May 2007) (Mar 2009)
8. Explain part vs whole and massed vs spaced method 6. Mention the meaning and nature of forgetting.
of learning. (Apr 2006) (Oct 2007)
9. What is learning and explain trial and error method 7. Discuss various economical methods of memoriz­
of learning? (April 2005) ation and how it is useful in edu­cation. (May 2007)
10. Enumerate the differences between learning by 8. Explain the factors influencing memory. (Oct 2006)
classical conditioning and operant conditioning. 9. What are the types of memory? How can memory
(April 2005) be improved? (Oct 2006)
11. What is classical conditioning with special reference 10. Explain the causes of forgetting. (Apr 2006)
to Pavlov? (April 2005) 11. What is forgetting? What are the causes of
12. Describe the operant conditioning by Skinner. forgetting? Describe the methods to improve
(2004) memory. (2004)
13. Discuss the different methods of learning with 12. Differentiate between long-term and short-term
suitable examples. (2004) memory. (2004)
14. Steps in learning. (Nov 2003) 13. Define memory. Explain the methods to improve
15. Explain educational implications of transfer of memory. (2004)
learning. (Nov 2003) 14. Elaborate effective ways of memorizing. (Nov 2003)
15. What is forgetting? Explain the organic (Bio­logical)
Short Answers causes of forgetting. (Nov 2003)
1. Reinforcement. (Mar 2012, Mar 2011)
2. Insightful learning. (Mar 2012, Mar 2009, Oct Short Answers
2006) 1. Chunking. (Mar 2012)
3. Learning. (Mar 2009) 2. Types of memory. (Mar 2012)
4. Extinction and spontaneous recovery. (Mar 2009, 3. Amnesia. (Mar 2011, Sep 2009, Oct 2006)
2004) 4. Short-term memory. (Mar 2011, Nov 2003)
5. Trial and error. (Apr 2008) 5. Mnemonics. (Aug 2010)
6. Maturation and learning. (May 2007) 6. Learning. (Mar 2009)
7. Transfer of learning. (Apr 2006) 7. Distributed practice in memorization. (May 2007)
8. List any four factors affecting learning. (2004) 8. What is forgetting? (2004)
9. “Aha! Effect” in insight learning. (Nov 2003) 9. Remembering.
10. Proactive and retroactive inhibition.
MEMORY
THINKING
Long Essays
1. What is memory? Explain the techniques to improve Long Essays
memory. (Aug 2010) 1. How would you define thinking? Describe the
2. What is forgetting? Explain theories of forgetting. process by means of which concepts are formed.
(Sep 2009) (Oct 2007)
 Cognitive Processes 91
Short Essays 3. What is IQ? Discuss the present status of intelligence
tests and its uses in nursing. (May 2007)
1. What is reasoning? Explain errors in thinking?
(Sep 2011) 4. Discuss the factors influencing intelligence.
2. Explain Piaget and Bruner’s contribution in concept (Apr 2006)
formation. (Apr 2008) 5. How intelligence is distributed in the general
3. What is concept, how it is developed? (Apr 2008) population? (Apr 2006, Apr 2005)
4. Describe the steps involved in scientific problem 6. Explain the nature and factors influencing creativity.
solving. (Oct 2007, Nov 2003) (April 2005)
5. What is thinking? Describe the types of thinking. 7. What is intelligence test and elucidate its uses with
(May 2007, 2004) examples? (April 2005)
6. What are errors in thinking? (May 2007) 8. What is IQ? Write a note on mental retardation and
7. What is thinking? What are the types of thinking? mentally superior. (2004)
Explain the influence of language on thought. (2004) 9. What are aptitudes? Write a note on the measurement
of aptitudes and skills. (2004)
10. Name the verbal and performance tests of intelli-
Short Answers gence. (2004)
1. Problem solving. (Mar 2012) 11. Define mental retardation. Explain the types of MR.
2. Tools of thinking. (Sep 2011, Apr 2006) (2004)
3. Thinking (Mar 2011, March 2009, Sep 2009, Sep 12. Nature and assessment of aptitudes. (Nov 2003)
2011, Mar 2009) 13. Bring out the steps in creative thinking. (Nov 2003)
4. Types of reasoning. (March 2009)
5. Errors in thinking. (Apr 2008)
6. Abstract thinking. (May 2007) Short Answers
7. Define concepts. (Oct 2006) 1. IQ. (Mar 2012)
8. Reasoning. (Apr 2006) 2. Creativity. (Mar 11, Oct 2007, April 2005, 2004)
9. Define thinking. Name the types of thinking. (2004) 3. Genius. (Aug 2010, Oct 2006)
10. What is inductive reasoning? (2004) 4. Intelligence. (Mar 2009)
11. Free thinking. (Nov 2003) 5. Steps involved in creative thinking. (Apr 2006)
6. Define intelligence. (Apr 2006, Nov 2003)
INTELLIGENCE 7. Who proposed the term “IQ”? How do you calculate
IQ? (2004)
Long Essays 8. Name any two tests each of intelligence and
personality. (2004)
1. What is intelligence? Explain the different tools
9. What is IQ? Who proposed this term? (2004)
used for the measurement of IQ. (2004)
2. What is intelligence? Discuss the various intelli­
gence tests and their use in a nursing situation. APTITUDE
(Nov 2003)
Short Answers
Short Essays 1. Aptitude. (Mar 2012, Aug 2010, Sept 2009)
1. Measurement of intelligence. (Mar 2011, Aug 2010) 2. Aptitude test. (Apr 2006)
2. Types of Intelligence tests. (Aug 2010, Sep 2009) 3. What are aptitudes? (2004)
 CHAPTER

4
Motivation
and Emotional
Processes

Psychology deals with not only what people do Need for oxygen, water and food are most fundamental
but also why they do so. Why they do and how for our survival and existence. Prolonged deprivation
they behave in a particular fashion at a particular of any of these needs may cause death. Oxygen is
moment can be understood in terms of motivation. the most essential of all needs because all body cells
Motivation is an organized condition of the organism, require oxygen for survival. Healthy people drink
which serves to direct behavior towards a certain fluids to satisfy thirst and maintain fluid balance.
goal. Motives are inferences from observations of Food is a physiological need. Balance is maintained
behavior. They are powerful tools for the explanation through digestive and metabolic processes.
of behavior and they allow us to make predictions
Temperature, rest and sleep are essential for survival.
about future behavior. The activating forces working
The human body functions best at 98.6°F (37oC).
in motivation may be named as needs, drives or
Rest and sleep allow time for the body to rejuvenate
motives.
and be free of stress.

NEEDS The need for satisfaction of the sex urge or desire to

seek sex experiences is not essential for the survival
Needs are general wants or desires and are said of the individual. But the satisfaction of this need and
to be the very basis of our behavior. Our behavior normal sexual behavior is most essential for a happy
and feelings about ourselves and others, our values domestic life and the continuity and survival of the
and priorities we set for ourselves all relate to our human species.
physiological and psychological needs. Every human
being has to strive for the satisfaction of his basic Psychosocial Needs
needs, if he is to maintain and actualize or enhance
himself in this world. They can be broadly classified The psychosocial needs are acquired through social
as biological and psychosocial needs. learning and contact with others. These needs
become dynamic forces underlying beha­vior. These
are linked with socio-cultural environ­ ment and
Biological Needs
psychological make up of an individual. These are
Biological needs are necessary for the survival of the also termed as secondary needs.
individual. These needs are generally caused by bodily The needs, which fall under this category are need
wants. These are also called physio­logical or unlearned for freedom, security, love and affection, recognition
needs. The biological needs include all our bodily and social approval, social company, self-assertion
or organic needs like need for oxygen, food, water, and self-actualization.
temperature, rest, sleep and sex, etc. These needs must  All human beings have an urge to remain free
be met at least to the minimum for maintaining life. and independent.
 Motivation and Emotional Processes 93
 Every one of us needs to feel secure, which stimuli involving the related need. Drives of any
means being protected from potential or actual nature are divided into two categories:
harm. Safety and security need also includes ™™ Biological or primary drive
trusting others and being free of fear, anxiety and ™™ Socio-psychological or secondary drive
apprehension.
 Love and belonging need includes the under­ Biological Drive
standing and acceptance of others in both giving Biological needs give birth to biological drives such
and receiving love and the feeling of belonging as hunger, thirst, sex and escape from pain. The
to families, peers, friends, neighbor­hood and a biological drives are basically unlearned in nature.
community. People who believe that their love They arise from our biological needs as a result of a
and belonging needs are unmet, feel lonely and biological mechanism called homeo­stasis.
isolated.
 Each one of us has an inherent desire to gain Homeostasis: Our body system constantly works
recognition and appreciation from others. to maintain optimum level of functioning between
 Man is called a social animal in the sense that input and output. For example, when blood sugar
he has a strong urge to be with his own kind and level drops, glands, stomach and other body parts
maintain social relations with them. send signals to the brain, which activate a hunger
 Every one of us has an inherent desire to get drive and make one feel hungry. After food has
an opportunity to rule or dominate over others. been consumed by the individual’s body it returns
It may vary in intensity from person to person, to a state of balance. This maintenance of an overall
but it is exhibited by all of us in one or the other physiological balance is called homeostasis. When
situation. there is an imbalance there is a need to restore
 We all have an inherent craving for the balance and a drive arises, which in turn serves as an
expression of our self and actualization of our instigator of behavior.
own potentialities.
Socio-psychological or Secondary
DRIVES Drive
It includes fear or anxiety, desire for approval, stri­
A drive is an aroused state resulting from some bodily ving for achievement, aggression and dependence.
or tissue need. This aroused condition motivates the These drives are not related to our physiological
individual to initiate behavior to remedy the need. needs and therefore do not arise on account of
For example, lack of food produces certain chemical imbalance in the body’s internal functioning. They
changes in the blood, indicating a need for food, arise from the socio-psychological needs and are
which in turn creates a drive state of arousal or said to be acquired through social learning as a
tension. The individual seeks to reduce this drive by result of one’s interaction with his socio-cultural
doing something to satisfy the need. environment. These drives move an individual to act
Need refers to the physiological state of tissue for the satisfaction of his socio-psychological needs,
deprivation, where as drive refers to the psycho­ which in turn act as a reinforcer of the behavior for
logical consequences of a need. Drive does not the continuity and maintenance of the behavior.
necessarily get stronger as need gets stronger. A Drives thus work as a basic activating force
starved individual may be so weakened by his great behind a behavior.
need for food that drive (the motivation to get it) is
weakened. People who have fasted for long periods
INCENTIVES
report that their feelings of hunger (drive level) come
and go even though their need for food persists. The Anything that incites rouses or encourages a person
strength of a drive depends upon the strength of the is termed as an incentive. Drives are influenced and
94 Psychology for Nurses

guided by incentives. Praise, appreciation, regards, ™™ It compels an individual to respond by creating a

bonus, etc. are examples of incentives. Incentive kind of tension or urge to act
works as a reinforcing agent, as it adds more strength ™™ It is a goal-directed activity, pursued till the
to a drive like adding fuel to the already ignited fire. attainment of the goal
A piece of candy, chocolate or a toy may work as ™™ Attainment of a goal helps in the release of
an incentive for a child to give more strength to his tension aroused by a specific motive
drive and as a result he may be further motivated to ™™ A change in goal may bring changes in the nature
act or behave in a desirable way. Whether primary and strength of the motive
or secondary drive, it is greatly affected and directed ™™ Motivation is an inner state or an aroused feeling.
by the incentives. These incentives work more ™™ We experience motives as feelings of want, need
forcefully in the case an individual who remains and desire
deprived of them for long. ™™ Motive may be considered as a learned response
or tendency and also an innate disposition
MOTIVES ™™ We cannot see motives directly, but must infer
them from the behavior of people.
A motive etymologically means that ‘which moves’.
A motive may be considered as an energetic force
TYPES OF MOTIVES
or tendency (learned or innate) working within the
individual to compel, persuade or inspire him to act for Some of the psychologists have divided motives into
the satisfaction of his basic needs or attainment of some two main categories:
specific purpose. Motives can be seen in the form of  Innate or unlearned
various needs, desires and aspirations of an individual.  Acquired or learned.
Motives can also be classified as:
Definitions  Physiological or primary motives
A need gives rise to one or more motives. A motive  Social or secondary motives
is a rather specific process, which has been learned.  Personal motives
It is directed towards a goal.  Unconscious motives
(Carol—1969)
A motive may be defined as a readiness or disposition Physiological or Primary Motives
to respond in some ways and not others to a variety Physiological motives are called biological or
of situations. organic motives. These include hunger, sex, thirst,
(Rosen, Fox and Gregory—1972) the need for oxygen, rest and sleep, avoid or seek
Motive is an inner state of mind or an aroused relief from pain, activity and the elimination needs.
feeling generated through basic needs or drives,
which compel an individual to respond by creating a Hunger Motive
kind of tension or urge to act.
Food is seen to be a very dominant motive. If hunger
Motive may thus be considered to be an energetic
motive is not adequately satisfied, beha­vior of the
force or tendency (learned or innate) working within
individual undergoes a series of changes, which
the individual to compel. Persuade or inspire him to
includes lowering of their morale. When the food
act either for the satisfaction of his basic needs or the
supply of the body has been exhausted, certain
attainment of some specific purpose.
biochemical changes take place in the tissues of the
body. This causes the stomach to contract, which
CONCEPTS OF MOTIVATION gives hunger pains. Hunger must be satisfied in order
™™ Motivation is generated through basic needs or to help the body to return to a physiological balance
drives or homeostasis.
 Motivation and Emotional Processes 95
Thirst Motive The nurse has to recognize all these basic needs
When deprived of water over a long period the and drives in her patients. She has to remember that
individual becomes excessively restless and needs due to illness many of these drives become weak and
intake of water. The tissues of the body lose fluid queer in their expression. She should provide care in
when fluids have not been taken in. As a result the such a way as to satisfy all basic needs of the patient.
mucous membranes of the throat become dry and
cause sensation of thirst. Social or Secondary Motives
Human beings are not only biological, but also social.
Respiratory Motive Therefore, human behavior is activated by social
It is the drive for air and oxygen. One cannot survive motives such as, affiliation motives, need for status,
for long without a regular supply of air or oxygen. power motives and social approval. These motives
When an individual suffers from oxygen want, his develop through relationship with people.
memory, sensory activity and muscular control are
seriously impaired. Affiliation Motives
We all love company. In general, pleasures of life
Need for Rest and Sleep cannot be enjoyed without company. We all resent
Need for sleep is one more physiological motive. loneliness. Even the simple routine activities of
When the body continues activities without rest or eating and drinking cannot be enjoyed without
sleep for a long time, it is possible to experience company. The need to be with other people is referred
confusion, fatigue and discomfort. to as affiliation need. It is revealed by a need to be
attached to others through friendship, sociability or
Need for Elimination of Waste group membership. Need to rely on others, which is
called dependency motive is one form of the need
When the bladder or intestine becomes distended with
for affiliation. The motive of affiliation is universally
waste material, they cause pressure and discomfort.
seen in all human cultures.
The person becomes restless until the waste materials
are disposed off and pressure relieved.
Need for Status
Sex Motive Almost all individuals have a desire to have some
standing or position among the people of his society
With the onset of puberty, the sex glands start
or group. Nobody likes to be considered inferior.
functioning and as a result the sex drive is stimulated.
Though it is a physiological drive it is regulated by
Power Motive
customs, traditions and religious conventions. A
number of taboos are associated with the satisfaction of The desire to be in a position of control, to be the boss,
sex drive. This motive within certain limits influences to give orders, to command respect and obedience is
man’s behavior a great deal. Its adequate satisfaction is called the power motive. Power motive directs the
desirable for the maintenance of normal mental health. behavior of dictators, gang leaders and the builders
It is considered a biological drive, since it is dependent of fraudulent financial empires.
on physiological conditions. Unlike hunger and thirst,
sex is not essential for the survival of the individual, Social Approval
but is necessary for the survival of the species. The We try our best to avoid doing anything that may
initial drive to sex activity comes from nerves tensions evoke social disapproval. We often show an almost
within the body set up by sex hormones. Its expression compulsive tendency to conform to the norms set by
is subject to moral codes and civil law. We have to our social group.
sublimate this sex drive by engaging ourselves with art A nurse has to remember that all these so-
and painting, creative writing, dramatics, etc. cial motives are at work in the life of her patients,
96 Psychology for Nurses

colleagues and in her own daily relationships. She Force of Habit

has to note the manifestations of these motives in her A habit which has been formed acts as a drive and
patients carefully, because some of them adopt pecu- compels us to continue the accustomed ways of
liar means to satisfy them. doing things. In other words, habits once formed
persist and influence our behavior greatly.
Personal Motives
Personal motives are allied with physiological needs Interests and Attitudes
and common social motives, but they are so much The interests we have developed and the attitudes we
individualized that they are no longer common. have formed color our everyday behavior in many
They are our wants and aspirations, which are not ways.
shared commonly by others. Need for achievement,
vocational ambitions and life goals, specific interests, Curiosity
habits and attitudes, levels of aspiration, curiosity
This is a motive, which is close to exploration.
and fear are our personal motives.
Exploration is a drive that aids the satisfaction
of curiosity. The extent of man’s knowledge and
Need for Achievement
experience widens as a result of this drive. Curiosity
Achievement motivation refers to a drive towards thus adds to our competency.
some standard of excellence. People with high need
for achievement prefer tasks which would promise Fear
success and are moderately difficult. David C
Fear is a learned motive. It motivates individuals to
McClelland has found that while high achievers tend
escape from fear producing situation. Fear may also
to succeed, low achievers tend to avoid failures. High
interfere with the satisfaction of other motives.
achievers challenge failures and work harder, while
The nurse should understand that personal
low achievers accept failure and go for less difficult
motives are no longer common. They are our wants
task. High achievers prefer personal responsibility
and aspirations, which are not shared commonly by
and like to get feedback about their works.
others. She has to put extra-attention to understand
the personal motives.
Vocational Ambitions and Life Goals
These desires are common to many others, but there Unconscious Motives
is something unique about each one’s desires. These
Unconscious motives are those of which we are not
are powerful determinants of our behavior.
aware of. They may be in the form of our repressed
desires or wishes or complexes. They determine our
Levels of Aspiration
irrational fears or phobias, our eccentric likes and
Levels of aspiration imply the degrees of expec­ dislikes, our chronic head­aches and gastric troubles
tation which a person has, i.e. how much he expects (for which we have no organic causes) and our
to accomplish or achieve. We may have the same neuroses and insanities.
ambition or life goal, but may have different levels According to Freud, it is the unconscious mind
of aspiration. In general people tend to set their that guides, directs and motivates dreams. The root
goals slightly higher than the level they are sure of cause of mental diseases is traced to the unconscious
attaining. This is a healthy tendency for progress. mind.
However, there are a few who set their level of
aspiration much higher or lower in comparison
THEORIES OF MOTIVATION
to their actual level of performance leading to
frustrations and disappointments. Repeated failure Theories of motivation try to provide general sets of
may lower the level of aspiration. principles to guide our understanding of the urges,
 Motivation and Emotional Processes 97
Table 4.1: Major approaches to motivation
Theory Main points
Instinct Innate biological instincts guide behavior
Drive reduction Behavior is guided by biological needs and learned ways of reducing drives arising from
those needs
Arousal People seek to maintain an optimal level of physiological arousal, which differs from
person-to-person. Maximum performance occurs at optimal arousal level
Incentive External stimuli direct and energize behavior
Hierarchy of needs Needs form a hierarchy; lower order needs must be fulfilled before higher-order needs
are met

wants, needs, desires and goals which fall under the Drive Theory (Push Theory
category of motivation (Table 4.1). of Motivation)
Drive theory was developed by Clark Leonard Hull
Instinct Theory of Motivation in 1943. According to the drive theory of motivation,
According to instinct theories, people are motivated people are motivated to take certain actions in order
to behave in certain ways because they are to reduce the internal tension that is caused by unmet
evolutionarily programmed to do so. An example of needs. For example, a person might be motivated
this in the animal world is seasonal migration. These to drink a glass of water in order to reduce the
animals do not learn to do this; it is instead an inborn internal state of thirst. Humans and other animals are
pattern of behavior. motivated by four drives: hunger, thirst, sex and the
avoidance of pain. This theory is useful in explaining
William James created a list of human instincts
behaviors that have a strong biological component,
that included such things as attachment, play, shame,
such as hunger or thirst. The problem with the drive
anger, fear, shyness, modesty and love. The main
theory of motivation is that these behaviors are not
problem with this theory is that it did not really
always motivated purely by physiological needs. For
explain behavior, it just described it. By the 1920s,
example, people often eat even when they are not
instinct theories were pushed aside in favor of other
really hungry.
motivational theories, but contemporary evolutionary
Drive theories might be described as the ‘push
psychologists still study the influence of genetics and theories of motivation’; behavior is ‘pushed’ towards
heredity on human behavior. goals by driving states within the person. Drive
According to William McDougall all beha­vioral theories say: when an internal drive state is aroused,
acts are essentially instinctive and this instinctive the individual is pushed to engage in behavior, which
behavior is found to have three aspects: will lead to a goal, reducing the intensity of the drive
 Cognitive (knowing) state. Motivation consists of:
 Affective (feeling)  A drive state.
 Conative (acting or doing)  Goal-directed behavior initiated by the drive state.
For example, when a child sees a monkey coming  The attainment of an appropriate goal.
towards him, first, he sees the monkey, second, he  The reduction of the drive state and subjective
experiences an emotion of fear and third, he tries satisfaction and relief when the goal is reached.
to run away. Thus, all human behaviors could be The sequence of events is called motivational
explained in terms of some instinct. cycle (Figure 4.1).
98 Psychology for Nurses

Drive theory includes the influence of learning Incentive Theory of Motivation

in secondary drives. Primary drives are those which (Pull Theory of Motivation)
arise from basic biological needs, such as hunger,
Incentive theory is based on behaviorists learning
thirst and elimination, etc. However, through the
theories proposed by Thorndike, Pavlov, Watson and
process of conditioning and learning, people can
BF Skinner (1977). The incentive theory suggests
acquire other drives. These learned drives are
that people are motivated to do things because of
known as secondary drives; people are said to have
external rewards. This theory emphasizes that an
learned drives for power, aggression or achievement,
attractive incentive energizes us to do something,
etc. Such learned driving states become enduring
while an unattractive incentive discourages us to
characteristics of the particular person and push him
do something. For example, a student is motivated
towards appropriate goals.
by the incentive of good grades and a teacher is
motivated by the incentive of a promotion.
Arousal Theory of Motivation In contrast with the push of drive theories,
Arousal is the level of alertness, wakefulness and incentive theories are pull theories of motivation;
activation caused by activity in the central nervous stresses that environmental stimuli may motivate
system. The optimal level of arousal varies with behavior by ‘pulling’ people towards them. We are
the person and the activity. The arousal theory of pushed by our drives and pulled by incentives. The
motivation suggests that people take certain actions drive is the need and the incentive is the reward.
to either decrease or increase levels of arousal. When
arousal levels get too low, for example, a person Maslow’s Hierarchy of Needs
might watch an exciting movie or go for a jog. When
Abraham Maslow (1960–1970), a leader in the
arousal levels get too high, on the other hand, a
development of humanistic psychology proposed
person would probably look for ways to relax such
an interesting way of classifying human motives
as meditating or reading a book. According to this
(Figure 4.3). He assumed a hierarchy of motives
theory, we are motivated to maintain an optimal level
ascending from the basic biological needs present
of arousal, although this level can vary based on the
at birth to more complex psychological motives that
individual or the situation (Figure 4.2).
become important only after the more basic needs
have been satisfied. The needs at one level must at
least be partially satisfied before those at the next

Figure 4.1: Motivational cycle Figure 4.2: Arousal theory of motivation

 Motivation and Emotional Processes 99
level become important determiners of action. When whole, rather than just a part. Maslow believed that
food and safety are difficult to obtain, the satisfaction people are motivated to seek personal goals, which
of these needs will dominate a person’s actions and make their lives rewarding and meaningful.
the higher motives will have little significance. Only Abraham Maslow suggested that five basic class-
when the satisfaction of the basic needs is easy, will es of needs or motives influence human behavior.
the individual have the time and energy for esthetic According to Maslow, needs at the lowest level of
and intellectual interests. Artistic and scientific hierarchy must be satisfied before people can be mo-
endeavors do not flourish in societies where people tivated by higher-level goals (Figure 4.4). According
must struggle for food, shelter and safety. to Maslow the five levels of moti­ves from bottom to
One of the basic themes underlying Maslow’s the top of the hierarchy are:
theory is that motivation affects the person as a
Physiological Needs
The physiological needs are most basic, powerful
and urgent of all human needs that are essential
to physical survival. Even, if one of these needs
remains unsatisfied, the individual rapidly becomes
dominated by it, so all other needs become secondary.
The needs, which are included in this group are food,
water, oxygen, activity, sleep, sex, homeostasis and
excretion.

Safety and Security Needs

Once the physiological needs are fairly well-
satisfied, safety and security needs predominate.
Figure 4.3: Abraham Maslow, leader in the develop­ment The needs, which are included in this level are the
of humanistic psy­chology need for security of body, employment, resources,

Figure 4.4: Maslow’s hierarchy of needs

100 Psychology for Nurses

morality, family, health and property. Safety needs of charac­teristics that distinguish self-actualized
are of greater importance in childhood. The failure to people from others:
satisfy the needs of children may make them fearful, ™™ They are realistically oriented.
insecure adults who are unable to cope with the ™™ They accept themselves for what they are.
ordinary demands of the environment. ™™ Their thought is unconventional and sponta­neous.
™™ They are problem centered.
Need for Love and Belongingness ™™ They have a need for privacy.
These needs become prominent when the physio­ ™™ They are independent.
logical and safety/security needs have been met. The ™™ Their appreciation of people is fresh.
person at this level longs for affectionate relationship ™™ They have spiritual experiences.
with others, for a place in his family and social groups. ™™ They identify with people.
The secure individual will be able to reach out for ™™ They have intimate relationships.
friends, affiliate with a group and ultimately take on the ™™ They are democratic.
responsibilities in marriage of being both a spouse and ™™ They have a good sense of humor.
a parent. The needs, which are included in this level are ™™ They do not confuse between means and ends.
need for friendship, family and sexual intimacy. ™™ They are creative and non-conformist.
™™ They appreciate the environment.
Self-Esteem Needs Maslow’s hierarchy provides a framework for
nursing assessment and for understanding the needs
Once people find themselves loved and loving
of the patient at all levels so that interventions to
members of an accepting circle, they then need to
meet the needs become a part of the care plans.
think highly of themselves and to have others think
highly of them. They want self-respect and the
respect, confidence and admiration of others. Maslow MOTIVES AND BEHAVIOR
divided these needs into two types: self-respect and ™™ Motives act as the immediate force to energize,
respect from others. direct, sustain and stop a behavior.
Self-respect includes a person’s desire for com- ™™ Motives are a powerful tool for explaining
petence, confidence, achievement and inde­pendence. behavior.
Respect from others includes his desire for prestige, ™™ Motives help us to make predictions about
reputation, status, recognition, appre­ciation and ac- behavior in many different situations.
ceptance from others. Satisfaction of self-esteem needs ™™ Motives do not tell us exactly what will happen,
generates feelings of self-confidence, self-worth and a they give us an idea about the range of things a
sense of being useful and necessary in the world. person will do. A person with a need to achieve
Dissatisfaction of self-esteem needs, in contrast, will work hard in school, business, work
generate feelings of inferiority, weakness, passi­vity situations, etc.
and dependency. ™™ Motives are inner forces that control an individual’s
behavior in a subtle manner.
Self-Actualization
According to Maslow, self-actualization is the highest FRUSTRATION
human motive. It is the need for self-fulfillment,
the sense that one is becoming everything that he Every action arises in response to a need. So, it is
is capable of being. The person who has achieved always directed towards a goal. The blocking of
this highest level presses towards the full use of his activity directed towards a goal results in frustration.
talents, capacities and potentialities. In short, the It always produces unpleasant feelings like anger,
self-actualized person is someone who has reached despair, irritation, anxiety, etc. This produces mental
the peak of his potential. Listed below are a number tension. For example, over restrictive parents would
 Motivation and Emotional Processes 101
be a source of frustration to an adolescent girl who Internal Factors
wanted to attend a party, while lack of water would  Physical abnormalities or defects.
be a source of frustration to a man lost in the desert.  Conflict of motives within the individual.
 The individual’s morality and high ideals.
Definitions  High levels of aspiration.
The word frustration has been derived from a Latin  Lack of persistence and sincerity in efforts.
word ‘Frustra’ meaning ‘obstruct’. Frustration refers
to the blocking of behavior directed towards the Reactions to Frustration
goal. Frustration means emotional tension resulting
The important reactions are as follows:
from the blocking of a desire or need.
 (Good, Carter V)
Direct Approaches
Characteristics of Frustration ™™ Increasing trials or improving efforts.
™™ Changing the goal to one that is more attainable.
 Frustration produces an emotional state, which
™™ Adopt to compromising means.
is always unpleasant. It creates tension or stress,
which varies from simple annoyance to heated
Restlessness and Tension
anger. The tension or stress aroused by frustration
affects the vital balance. When increased effort and variation in attack fail and
 Frustration is a stage or condition in which failure substitute goals are unavailable and unacce­ptable,
dominates the attempts. person shows restlessness and tension behavior.
 In this state one experiences a major obstacle in
Aggression
the satisfaction of one’s basic needs or goals.
 The significance of the goal and strength of the Direct aggression: Sometimes aggression is ex-
blockade increases the degree of frustration. pressed directly against the individual or object,
 The cause of frustration lies both in the individual which is the source of frustration.
himself and his environment. Displaced aggression: When circumstances block
direct attack on the cause of frustration, aggression
Causes or Source of Frustration may be ‘displaced’. Displaced aggression is an
There are two kinds of frustration. One is external aggressive action against an innocent person or object
and one is personal. External frustration is caused by rather than against the actual cause of the frustration.
conditions outside of oneself. Personal frustration is
caused by conditions within oneself. These conditions Apathy
can be categorized into external and internal factors: Those who find that they have no power to satisfy
their needs by means of their own actions, whose
External Factors (Environmental Factors) aggressive outbursts are never successful, may well
 Physical factors: Natural calamities, obstacles in resort to apathy and withdrawal when confron­ted
environment to reach a goal, environmental situ- with a frustrating situation.
ations or conditions, which we cannot control.
Fantasy
For example, a contagious disease, death of a
friend or a beloved relative. When problems become too much for an indi­vidual
 Social factors: Conflicts with other people, customs, to handle, he sometimes seeks the solution of escape
traditions, restrictions, taboos, laws, codes, etc. into a dream world, a solution based on fantasy
 Economic factors: Financial problems. rather than reality.
102 Psychology for Nurses

Stereotype Approach-approach Conflict

Stereotype is a repetitive, fixed behavior. When Approach-approach conflict occurs when a person is
repeated frustration baffles a person, some flexibility forced with two attractive alternatives, while only one
appears to be lost and the person will stupidly make of them can be selected. For example, there are two
the same effort again and again, though experience courses that you want to take, but they are scheduled
has shown its futility. for the same time. Approach-approach conflicts are
usually easy to resolve. But, they become serious, if
Regression the choice of one alternative means the loss of an
Regression is defined as a return to more primitive extremely attractive alternative (Figure 4.5).
modes of behavior, that is to modes of behavior
characterizing a younger age. Individuals show Avoidance-avoidance Conflict
considerable variability in behavior when their goal- Avoidance-avoidance conflict arises when a person
seeking behavior is blocked. faces two undesirable situations and avoidance of one
forces exposure to the other. These types of conflicts are
CONFLICT very difficult to resolve and create intense emotions. For
Conflict in life is one cause of stress. Conflict is a example, a woman trying to choose between continuing
painful state or condition of an individual. During an unwanted pregnancy and getting an abortion done
this state the person experiences an intense emotional (she may morally be opposed to abortion) (Figure 4.6).
tension. Conflict occurs when one has to choose
between equally desirable or equally undesirable Approach-avoidance Conflict
goals. These desires are contradictory in nature and Approach-avoidance type of conflict exists when one
therefore, cannot be satisfied fully at the same time. event or activity has both attractive and unattractive
Thus, becoming a victim of the two opposing desires, features. The result is continuing oscillation between
he suffers from an inner conflict to either satisfy or approach and avoidance, creating a great deal of
not satisfy one or the other desire. emotional conflict and stress. For example, to marry
or not to marry (Figure 4.7).
Definition
Conflict means a painful emotional state, which Multiple Approach-avoidance Conflict
results from a tension between opposed and contra- Multiple approach-avoidance conflict exists when a
dictory wishes. choice must be made between two or more alterna-
 (Douglas and Holland) tives, each of which has both positive and negative
features. Such conflicts are the most difficult to re-
Types of Conflict
 Approach-approach conflict
 Avoidance-avoidance conflict
 Approach-avoidance conflict
 Multiple approach-avoidance conflict
Figure 4.6: Avoidance-avoidance conflict

Figure 4.5: Approach-approach conflict Figure 4.7: Approach-avoidance conflict

 Motivation and Emotional Processes 103
™™ Identify the source of frustration, try to change or
control it. If cannot, learn to accept it.
™™ Decide important things carefully, check every-
thing carefully before taking a decision.
™™ Review the situation again.
Figure 4.8: Multiple approach-avoidance conflict ™™ Change our goals or modify our desires.
™™ Substitute our goals by others, which are equally
solve and to make the right decision, the individual satisfying but are different and obtainable.
must analyze the expected values of each course of ™™ Seek advice from experts, friends or relatives.
action. ™™ Encourage full expression of positive and
For example, a person may have the alternative negative feelings within an accepting atmos­
of accepting any of the two jobs, of which one may phere.
be boring, but with a very good pay and other may be ™™ Avoid indecision. Stick with decisions and forget
interesting, but with a very poor pay. Either choice about the other choices.
has a positive and a negative quality, so which one
does he choose? The choice will be based on the
person involved and his feelings about the pay or
EMOTIONS AND STRESS
work involved. Etymologically the word ‘emotion’ is derived from
When it is difficult to decide in a double approach- the Latin word, ‘emovere’ which means ‘to stir up’
avoidance conflict people usually vacillate. That is, or ‘to excite’. In common usage emotion is referred
they waver or go back and forth between the two to as a subjective feeling.
choices (Figure 4.8). Feelings are simple experiences of the affective
type, pleasant or unpleasant. Emotions are more
Internal Conflicts complex affective experiences in which the whole
Conflicts may be between one person and another individual is stirred up. Emotions are some sort
or between a person and his environment or may be of feelings or affective experiences, which are
within the person himself. The most dangerous and characterized by some physiological changes that
serious conflict is the one within a person. This is generally lead them to perform some or the other
called internal conflict, the conflict between one’s types of behavioral acts.
motives, desires, sentiments and attitudes. Freud
describes it as a conflict between the forces of the id, Definitions
the ego and the super-ego, the three dynamic aspects Emotion is a ‘moved’ or ‘stirred-up’ state of an
of one’s personality. organism. It is a stirred-up state of feeling that is
Our internal conflict may be conscious or the way it appears to the individual himself. It is a
unconscious. We are aware of its causes or sources disturbed muscular and glandular activity that is the
when it is at the conscious level, whereas, we are not way it appears to an external observer.
aware of the real motives causing the conflict at the  (Woodworth—1945)
unconscious level. The conflict at the unconscious Emotion is an affective experience that accompanies
level is responsible for many of our emotional generalized inner adjustment and mental and
disorders and mental illnesses. physiological stirred-up states in the individual and
that shows itself in his overt behavior.
RESOLUTION OF FRUSTRATION  (Crow and Crow—1973)
AND CONFLICT
COMPONENTS OF EMOTION
Frustration and conflict lead to stress and anxiety
causing harm to the body. Some methods of relieving Dennis Coon described four components of emotion
frustration are: (Figure 4.9):
104 Psychology for Nurses

clenches his fists and moves forward to attack. In

fear a person runs away, in joy the person is excited,
holds his head high and chest out.

Physiological Changes
Physiological changes that take place during an
emo­ tional state are caused mainly by the auto­
nomic nervous system and the endocrine gland
system. The autonomic nervous system has two
subdivisions—the sympathetic division and the para-
sympathetic division. The sympathetic division of
Figure 4.9: Components of emotion
the autonomic nervous system pre­pares the body for
emergency action during aroused states. It causes
Subjective Feeling discharge of hormones, epinephrine (adrenaline)
and norepinephrine (noradrenaline). Adrenaline gets
Subjective feelings are what you believe and what
circulated to different parts of the body through blood
you are feeling. It is conscious and an intellectual
and is responsible for the following physical changes:
perception of a situation, if the situation is intense
™™ Increased blood pressure (BP) and heart rate.
enough, it may provoke an emotion. Emotional
™™ Changes in the rate of respiration.
feelings are experienced before expression.
™™ Dilation of pupils.
™™ Sweating and decreased secretion of saliva.
Emotional Expression or Expressive
™™ Increase in blood sugar level.
Behavior ™™ Decreased mobility of the gastrointestinal tract.
There are three ways in which an emotion can be ™™ Erect hair on the skin.
expressed: ™™ Muscular tensions and tremors.
 Facial When a period of intense emotion ends, the
 Vocal physiological response of the body is taken over
 Bodily movements/gestures by the parasympathetic branch of nervous system.
This system slows down the entire metabolism of
Facial the body to bring it into balance once again. The
The face is believed to be the most expressive part parasympathetic system acts much more slowly
of the body. Some emotions like guilt, joy, anger, than the sympathetic system. This is why the body
etc. can be perceived fairly accurately through facial responds very quickly to an intense emotion, but
expressions. recovers its balance very slowly. The physiological
changes produced by the parasympathetic nervous
Vocal system are as follows:
Voice also tells us about an emotional state of an ™™ Reduces heart rate and BP.
individual. A scream communicates fear, surprise or ™™ Diverts blood to the internal organs and digestive
pain; a trembling voice means sorrow or disappointment; tract.
a loud, sharp, high-pitched voice means anger, ™™ It regulates the salt and water level of the body.
irritability or frustration. Slow monotonous voice ™™ It helps to build up and conserve the body’s
usually communicates sadness. energy.

Bodily Movements or Gestures Conscious Experience

Bodily movements and gestures also indicate the An emotion is not only a pattern of bodily changes,
emotional state of an individual. In anger, a person but also an experience. Emotional experience is
 Motivation and Emotional Processes 105
Table 4.2: Changes in emotional reactions
External changes Internal changes Psychological changes
• Facial expression • Increased heart rate • Clouding of consciousness
• Bodily movements • Increased blood pressure • Blocking of memory
• Gestures • Changes in respirations • Decreased learning capability
• Voice disturbances • Increased blood sugar level
• Decreased motility of gastrointestinal system

generally a conscious feeling. In order to assess an which the eyes close, mouth widens, head and neck
individual’s emotion, his feelings and emotional are thrust forward. In anger one may clench ones fists
experience is an important indicator. and move to attack.
Voice disturbances: A tremor or a break in the
CHANGES IN EMOTIONAL REACTIONS voice may denote deep sorrow. A loud, sharp high-
pitched voice usually denotes anger. Speech is low
Emotional reactions affect the autonomic nervous and monotonous in dejection and sadness and rapid
system the most. The following external, internal and in tension and excitement.
psychological changes occur during emotional states
(Table 4.2 and Figure 4.10). Internal Changes
External Changes During fear and anger, the pulse rate or heart rate
increases. Blood pressure increases during emotional
Facial expressions: They differ in different emotional
excitement. During excitement breathing is in short
reactions. The face is flushed in anger and pale in
quick gasps, but in depression it is slow.
fear. Mouth turns down in unpleasant emotions and
turns up in pleasant emotions.
Psychological Changes
Bodily movement and gestures: Unexpected
fearful situation might cause a startle pattern in During emotional experiences, perception, learning,
consciousness and memory are affected.

THEORIES OF EMOTION
Psychologists have proposed a number of theories
about the origin and functions of emotion. However,
the theorists behind the dissenting views do agree
that emotion has a biological basis. This is evidenced
by the fact that the amygdala (part of the limbic
system of the brain), which plays a large role in
emotion, is activated before any direct involvement
of the cerebral cortex (where memory, awareness,
and conscious ‘thinking’ take place).
In the history of emotion theory, four major
explanations for the complex mental and physical
experiences that we call ‘feelings’ have been put
forward. They are: the James-Lange theory in the
1920s, the Cannon-Bard theory in the 1930s, the
Figure 4.10: Various emotional reactions Schachter-Singer theory in the 1960s, and most
106 Psychology for Nurses

recently the Lazarus theory, developed in the 1980s Example: You are late leaving work and as you head
and ‘90s (Table 4.3). across the parking lot to your car, you hear footsteps
behind you in the dark. Your heart pounds and your
James-Lange Theory hands start to shake. You interpret these physical
In 1880, S William James formulated the first responses as fear.
modern theory of emotion, at almost the same
time a Danish psychologist Carl Lange reached the
same conclusion independently. The James-Lange
theory proposes that an event or stimulus causes a
physiological arousal without any interpretation or
conscious thought and you experience the resulting
emotion only after you interpret the physical
response (Figure 4.11). Figure 4.11: James-Lange theory

Table 4.3: Theories of emotion

 Motivation and Emotional Processes 107
Cannon-Bard Theory states are a function of the interaction of cognitive
Cannon-Bard theory was proposed by Walter factors and a state of physiological arousal.
Cannon and Philip Bard in the 1920s. The Cannon- The Schachter-Singer theory takes a more
Bard theory, on the other hand, suggests that the cognitive approach to the issue. He believes that an
given stimulus evokes both a physiological and an event causes physiological arousal, but that you must
emotional response simultaneously and that neither then identify a reason for the arousal before you label
one causes the other. According to Cannon’s theory, the emotion (Figure 4.13).
the emotional experience occurs as soon as the cortex The conscious experience of emotion involves
receives the message from the thalamus; it does not the integration of information from three sources:
™™ Feedback to the brain from the internal organs
depend upon the feedback from internal organs and
skeletal responses (Figure 4.12). and other body parts activated by the sympa­
thetic nervous system
Example: You are home alone and hear creaking in ™™ Subject interpretation of aroused state
the hallway outside your room. You begin to tremble ™™ Information stored in memory and the per­ception
and sweat and you feel afraid. of what is taking place in the environ­ment, i.e.
memory of past experience and appraisal of
Schachter-Singer Theory (1962) current situation.
Schachter-Singer theory is called “cognitive theory Example: You are taking the last bus of the night and
of emotion”. Schachter proposed that emotional 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 tingles down your spine with
a rush of adrenaline. You know that there have been
several muggings in your city over the past few
weeks, so you feel afraid.

Lazarus Theory
The Lazarus theory builds on the Schachter-Singer
Figure 4.12: Cannon-Bard theory
theory, taking it to another level. It proposes that

Figure 4.13: Theoretical model of Schachter-Singer theory

108 Psychology for Nurses

when an event occurs, a cognitive appraisal is Autonomic Nervous system

made (either consciously or subconsciously) and Autonomic nervous system prepares the body
based on the result of that appraisal, an emotion and for emotional responses by its two divisions—
physiological response follow (Figure 4.14). sympathetic and parasympathetic nervous system.
Example: You are buying a few items at the super Sympathetic nervous system is more active in
store, when two young men in hooded sweatshirts unpleasant situations, while the parasympathetic
enter the store in a hurry, with their hands in their division is more active with more pleasant situations.
jacket pockets. You think perhaps they are here to Strong emotional reactions like fear, anger, etc.
rob the place, so you get scared and feel like you stimulate the sympathetic nervous system that
might throw up. releases hormones from the adrenal gland.
While each of these theories is based on research, The parasympathetic nervous system makes us
there is no absolute proof as yet how emotions arise calm by inhibiting the release of these hormones.
in our bodies and minds or what determines our own
individual experiences of them. What we do know is Brain Structures
that feelings are a powerful force to be reckoned with Hypothalamus and limbic system are the structures,
and should never be belittled. which control emotional systems by signaling the
pituitary gland to release epinephrine, which is
EMOTIONAL ADJUSTMENTS associated with the sympathetic nervous system.
Amygdala is another key player within the
Emotional adjustment (also referred to as emotional
limbic system, receives information from the cortex
equilibrium, emotional stability, neuroticism, per-
and thalamus, involves in processing emotions
sonal adjustment or psychological adjustment) is the
like patterns of attack, defence and flight. Right
maintenance of emotional equilibrium in the face of
hemisphere regulates facial expressions and the left
internal and external stressors. This is facilitated by
hemispheres, deciphers emotional tone from the
cognitive processes of acceptance and adaptation.
messages we fear.
An example would be maintaining emotional control
and coping behavior in the face of an identity crisis.
Emotions play an important role in human life. Hormones
Under ordinary circumstances the physiological Hormones play an important role in regulation
reactions during an emotion facilitate the adjustment of emotions. During emotional states there is an
of the individual and these physiological reactions do increase in hormonal level in the blood and urine.
not last a long time and not have any harmful effects
on our body. But when an emotion recurs again EMOTIONS IN HEALTH AND ILLNESS
and again and remains for a longer time, troubles
Dr Schindler says—by controlling our own emotions
may start, affecting the physical health. Autonomic
we can eliminate half of the nagging illnesses that
nervous system, brain structures and hormones play
plague our daily lives. Our body functions well when
an important role in emotional adjustment.

Figure 4.14: Lazarus theory

 Motivation and Emotional Processes 109
we are happy. There is an old saying, ‘Joy is the best  When a person faces a stressor, responses are
medicine’. referred to as coping strategies, coping respon­ses
 Intense and unpleasant emotions disturb the or coping mechanisms.
whole individual; if they persist they may cause
illness or worsen the condition of one already ill. Definitions
 Ordinarily physiological reactions during an
emotion facilitate the adjustment of the individual Stress is the “non-specific response of the body to
and these reactions do not last a long time and not any kind of demand made upon it”.
have any harmful effects on our body. But when (Selye—1956)
an emotion recurs again and again and remains Stress is the arousal of mind and body in response to
for a long time, troubles may start, affecting the demands made upon them.
physical health.  (Schafer—2000)
 Modern medicine shows that uncontrolled
emotionality plays a vital role in the causation of STRESSORS
many physical disorders, which include: Stressor can be any stimulus that causes an indi­
−− Peptic ulcer
vidual to experience stress. Three major categories
−− Heart diseases
of stressors are:
−− Epilepsy
 Catastrophic events.
−− Diabetes and tuberculosis (TB) are made worse
 Important life events (personal stressors).
−− Bronchial asthma
 Daily hassles (background stressors).
−− Increased BP
−− Insomnia, chronic constipation
Catastrophic Events
−− Functional colitis
−− Skin disorders like pruritus, psoriasis, etc. A catastrophe is a large scale disaster that affects
−− Susceptible to infections numerous people and causes extensive damage.
A nurse has to reduce the intensity of emotional Catastrophes include earthquakes, hurricanes, war,
disturbances as much as it is possible for her. toxic waste contamination and nuclear accidents.
Stress induced by catastrophic events is shared by
STRESS others who have also experienced the disaster. This
permits people to offer one another social support.
Concepts of Stress
 Stress is a universal phenomenon. All people Important Life Events
experience it. Major life events such as the death of a family member,
 Stress can have both positive and negative effects. which has immediate negative consequences usually
 Stress is produced by a change in the environ­ment fades with time. The major life events are death of a
that is perceived as a challenge, threat or danger. parent or spouse, the loss of one’s job, diagnosis of
 Stress affects the whole person in all the human a life-threatening illness, parent or relative in family
dimensions (physical, emotional, intellectual, getting very sick, breaking up with a close friend,
social and spiritual). The perception of stress and starting a new school, moving to a new home, starting
the responses to it are highly individualized, not a new job, brother or sister getting married, etc.
only from person-to-person but also from one Typically personal stressors produce an immedi-
time to another in the same person. ate major reaction. For example, stress arising from
 Stress is a condition in which the human system the death of a loved one tends to be greatest just
responds to changes in its normal balanced state. after the time of death, but people begin to feel less
110 Psychology for Nurses

stressed and are better able to cope with the loss after Ways to reduce stress: Avoiding or managing the
the passage of time. stress, choosing what is important in life, time
management, simple living, learning to say no, etc.
Daily Hassles
These are the minor irritants of life that we all face Reaction to Stress
time and time again: traffic delays, noise, pollution, Once there is a stressor our body will react to it.
weather, social events, work demands, dissatisfaction Reactions to stress relates to perception of the stress.
with school or job, being in an unhappy relationship, When a person feels stressed from the stressor, the body
people’s irritating behavior, not enough time, too begins to release chemicals to confront the stressor.
many things to do, concerns about standards, too
many responsibilities and so on. Reducing the reactions to stress: Asking God for
By themselves, daily hassles do not require help, spiritual practices, cognitive behavior therapy,
much coping on the part of the individual, although reframing the problem, visualization of results.
they certainly do produce unpleasant emotions and
moods. Yet, daily hassles add up and ultimately Wear and Tear on the Body and
they can produce as great a toll as a single, more Organ System
stressful incident. In fact, the number of daily hassles
When a person becomes stressed and does not
that people face is associated with psychological
correct the stressor, the same stress reactions which
symptoms and health problems such as sore throat,
helped in the beginning to cope, begin to wear one
flu and backaches.
self-down.
Uplifts: Minor positive events that make one
Remedies: Improving diet, regular exercises, yoga,
feel good. Uplifts range from relating well to a
meditation. All these activities reduce the emotional
companion to finding ones surroundings pleasing.
and physical effects of stress.
Common uplifts are relating well with spouse or
lover or friend, completing the task, feeling healthy,
Reduced Optimum Health
getting enough sleep, eating out, spending time with
family, meeting responsibilities and so on. These After a sustained period of chronic stress the
uplifts are associated with people’s psychological body wears down, which can invite more serious
health in just the opposite way that hassles are; the
greater the number of uplifts experiences the fewer
the psychological symptoms people later report.

STRESS CYCLE
Stress follows a cycle of events, which circle around
and around. Each step increases the severity of the
next step (Figure 4.16).

Stressor
Stressor can be any stimulus that causes an indi­vidual
to experience stress. Stressors include either positive
or negative life events, e.g. death, divorce, new job,
marriage, etc. Stressors cause pressures, challenges
or demands in life. Figure 4.16: Stress cycle
 Motivation and Emotional Processes 111
diseases like high BP, heart problems, diabetes, skin  People under stress may not engage in positive
conditions, asthama, arthritis, depression and even health-related behaviors and this may lead
cancer. Many diseases are associated with chronic to illness. When we are stressed, we may be
stress. less likely to engage in healthy behaviors. For
Remedies: Consulting allopathic or homeopathy example, students taking exams stay up for most
doctor or acupuncturist or naturopath to make a plan part of the night for several days, skip meals and
for regaining health. snack on junk food.
 During stress some men consume excessive
Increased Sensitivity to Stress amount of alcohol and smoke excessively.
People under stress cease normal exercise
While once body is worn down and emotions routines and become sedentary. Smoking is one
worn and exhausted, sensitivity to stress increases. of the leading causes of cardiovascular disease
Overtime, a smaller and smaller stressor initiates the and emphysema. A high-fat diet contributes to
same stress reaction that a big event used to get. many forms of cancer as well as cardiovascular
Remedies: Try deep breathing or meditation, taking diseases.
walks or talking with an objective friend may help to  People who do not regularly engage in a moderate
reduce sensitivity to stress. amount of exercise are at an increased risk for
heart disease and earlier death. Excessive alcohol
EFFECTS OF STRESS consumption can lead to liver and cardio­vascular
diseases and may also contribute to cancers.
Stress is not always harmful. In fact it is recognized  Stress may indirectly affect health by reducing
that low levels of stress can even help for better rates of positive health-related behaviors and
performance. For example, a student can prepare increasing rates of negative behaviors. People
well for examination only, if she has some stress. who engage in a healthy lifestyle—eating a low-
However, excessive levels of stress are undoubtedly fat diet, getting enough sleep and exercising
harmful. regularly often report that stressful events seem
 The body reacts to stressors by initiating a more manageable and that they feel more in
complex sequence of responses. If the perceived control of their lives.
threat is resolved quickly, these emergency  Thus, engaging in healthy behaviors can help
responses subside. But if the stressful situation reduce the stressfulness of life as well as reducing
continues, a different set of internal responses the risk or progression of a number of serious
occurs as we attempt to adapt. Attempts to diseases (Figure 4.17).
adapt to the continued presence of a stressor Three major types of consequences result from
may deplete the body’s resources and make it stress (Figure 4.18):
vulnerable to illness. It results in wear and tear  Direct physiological effects
from chronic overactivity of the physiological  Harmful behaviors
response to stress.  Indirect health related behaviors
 Chronic stress can lead to physiological disorders
such as ulcers, high BP and heart diseases. It
ADAPTATION TO STRESS
may also impair the immune system, decreasing
the body’s ability to fight invading bacteria and All of us face stress in our lives. Some psychologists
viruses. believe that daily life actually involves a series
 Stress may affect health directly by creating of repeated consequences of perceiving a threat,
chronic over arousal of the sympathetic division considering ways to cope with it and ultimately
of the autonomic nervous system or the adrenal- adapting to threat with greater or lesser success.
cortical system or by impairing the immune Although adaptation is often minor and occurs
system. without our awareness, adaptation requires major
112 Psychology for Nurses

Figure 4.17: Effects of stress

Figure 4.18: Major types of consequences resulting from stress

 Motivation and Emotional Processes 113
effort when the stress is more severe or long lasting. of the autonomic nervous system and the adrenal
Ultimately, our attempts to overcome stress can medulla. The alarm reaction is meant to counteract
produce biological and psychological responses that a danger by mobilizing the body’s resources for
result in health problems. immediate physical activity.
The stress responses, which characterize the
General Adaptation Syndrome (GAS) alarm reaction include the following:
(Hans Selye, 1945)  Heart rate and strength of cardiac muscle
Homeostatic mechanisms are aimed at coun­teracting contraction increases; this circulates blood quickly
the everyday stress of living. If they are successful, to areas where it is needed to fight the stress.
the internal environment main­tains normal physi-  Blood vessels supplying to the skin and viscera,
ological limits of temperature, chemistry and pres- except heart and lungs, constrict; at the same time
sure. If stress is extreme or long lasting, the normal blood vessels supplying to the skeletal muscles
mechanisms may not be sufficient. In this case, the and brain dilate; these responses route more
stress triggers a wide-ranging set of bodily changes blood to organs active in the stress responses,
called the general adaptation syndrome (GAS). thus decreasing blood supply to organs, which do
Hans Selye, a pioneering stress theorist developed not assume an immediate active role.
GAS model that suggests that a person’s response to  Red blood cells (RBC) production is increased
stress consists of three stages (Figure 4.19): leading to an increase in the ability of the blood
 Alarm to clot. This helps control bleeding.
 Resistance  Liver converts glycogen into glucose and releases
 Exhaustion it into the bloodstream; this provides the energy
™™ When stress appears, it stimulates the hypo­ needed to fight the stressor.
thalamus to initiate the GAS through two  The rate of breathing increases and respiratory
pathways: passages widen to accommodate more air; this
−− The first pathway is stimulation of the enables the body to acquire more oxygen.
sympathetic division of the autonomic  Production of saliva and digestive enzymes
nervous system and adrenal medulla. This reduces. This reaction takes place as digestive
produces an immediate set of responses activity is not essential for counteracting stress
called the alarm reaction. (Figure 4.20).
−− The second pathway, called the resistance
reaction involves the anterior pituitary gland Resistance Reaction
and adrenal cortex; the resistance reaction is
 The resistance reaction is the second stage in
slower to start, but its effects last longer. the stress response. It is initiated by regulating
hormones secreted by the hypothalamus and is
Alarm Reaction or Fight-or-Flight Response a long-term reaction. These regulating hormones
Alarm reaction is the body’s initial reaction to a are corticotropin-releasing hormone (CRH),
stressor. It is a set of reactions initiated when the growth hormone-releasing hormone (GHRH)
hypothalamus stimulates the sympathetic division and thyrotropin-relea­sing hormone (TRH).

Figure 4.19: Three-stage model of general adaptation syndrome

114 Psychology for Nurses

 CRH stimulates the anterior pituitary to increase Exhaustion Stage

its secretion of adrenocorticotropin hormone At this stage, the cells start to die and the organs
(ACTH). ACTH stimulates the adrenal cortex to weaken. A long-term resistance reaction puts heavy
secrete more of its hormones. The action of these demand on the body, particularly on the heart, blood
hormones helps to control bleeding, maintain BP, vessels and adrenal cortex, which may suddenly fail
etc. under the strain. In this respect, ability to handle
 GHRH stimulates the anterior pituitary to secrete stressors is determined to a large extent by the
human growth hormone (HGH). TRH causes the general health.
anterior pituitary to secrete thyroid-stimulating Theorists have argued that Selye’s model is lim-
hormone (TSH). The combined actions of HGH ited because it does not give importance to psycho-
and TSH help to supply additional energy to the logical factors.
body.
 The resistance reaction allows the body to COPING WITH STRESS
continue fighting a stressor for a long time. Thus,
it helps us to meet emotional crisis, per­ form Coping refers to the thoughts and behaviors we
strenuous tasks, fight infection or resist the threat use to handle stress or anticipated stress. Coping
of bleeding to death. includes efforts to control, reduce or learn to tolerate
 Generally, the resistance reaction is successful in the threats that occur due to stress. Effective coping
helping us cope with a stressful situation and our depends on the nature of the stressor and the degree
bodies then return to normal. Occa­sionally it fails to which it is possible to control it. Coping strategies
to fight the stressor, especially if it is too severe fall into three categories (Figure 4.22):
or long lasting. In this case, the GAS moves into  Emotion-focused coping
the stage of exhaustion (Figure 4.21).  Problem-focused coping
 Avoidance coping

Emotion-focused Coping
In this coping people try to manage their emotions in
the face of stress, seeking to change the way they feel
about or perceive a problem. Examples of emotion
focused coping include accepting sympathy from
others, seeking social support, denial of stress, etc.
Emotional-focused strategies are more frequently
used when stressful situation is unchangeable.

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
leads to change in behavior or to the development of
a plan of action to deal with stress. Starting a group
study to improve poor classroom performance is
an example of problem-focused coping. Problem-
Figure 4.20: Diagrammatic representation of focused approaches are more commonly used where
alarm reaction the stressful situation is relatively modifiable.
 Motivation and Emotional Processes 115

Figure 4.21: Diagrammatic representation of resistance reaction (CRH = Corticotropin releasing-hormone, GHRH = Growth
hormone-releasing hormone, TRH = Thyrotropin-relea­sing hormone, ACTH = Adrenocorticotropin hormone, HGH = Human
growth hormone, TSH = Thyroid-stimulating hormone)

Coping Styles According to Roger and

Nash (1995)
According to Roger and Nash, the coping styles are
adaptive and maladaptive (Tables 4.4 and 4.5).
 Adaptive styles involve an appropriate adjustment
Figure 4.22: Types of coping strategies
to the environment and gaining from the
In most stressful incidents, people employ both experience. These can be detached or rationale.
emotion-focused and problem-focused coping  Maladaptive styles involve failing to adjust
strategies. to environment and experiencing misery and
unhappiness as a result. These can be emotional
Avoidance Coping and avoidance coping styles.
In this coping style people try to minimize or avoid
threatening event. People who cope using avoidance Classification of Coping Strategies
may not make enough cognitive and emotional According to Cohen and Lazarus (1979)
efforts to anticipate and manage long-term problems.  Direct action response: The individual tries
Avoidance strategies are more effective in dealing to directly change or manipulate the stressful
with short-term threats. situation such as coping with or removing it.
116 Psychology for Nurses

Table 4.4: Adaptive coping styles

Detached Rationale
• Not seeing the problem or situation as a threat • Taking action to change things
• Keeping a sense of humor • Taking one step at a time and approaching the
problem with logic
• Resolving the issue by dividing things into parts • Using past experience for working out how to deal
with the situation
• Taking nothing personally and seeing the problem • Giving the situation full attention and treating it as a
as separate from one self challenge to be met

Table 4.5: Maladaptive coping styles

Emotional Avoidance
• Feeling helpless, miserable, depressed and angry • Pretending there is nothing, if people ask
• Showing frustration on other people • Sitting simply and hoping it all goes away
• Preparing for the worst possible outcome and • Thinking about something else and talking about the
seeking sympathy from others matter as little as possible
• Trusting in fate and believing things will sort
themselves out

 Information seeking: The individual tries to Definitions

understand the situation better and predict future An attitude can be defined, as an enduring organi-
events that are related to the stress. zation of motivational, emotional, percep­ tual and
 Inhibition of action: Doing nothing. cognitive processes with respect to some aspect of
 Intrapsychic or palliative coping: The individual the individual’s world.
reappraises the situation (use of psychological
(Krech and Crutchfield—1948)
defense mechanisms) or change the internal
An attitude may be defined as a learned and more
environment (through drugs, alcohol, relaxation
or less generalized and an effective tendency or
or meditation).
predisposition to respond in a rather persistent
 Turning to others: Seeking others help or emo-
and characteristic manner, usually positively or
tional support.
negatively (for or against in reference to some
situation, idea, value, material object or class) of
ATTITUDE such objects or person or group of persons.
 (Young K)
Meaning
Attitude is a specific mental state of an individual CHARACTERISTICS/NATURE
towards something according to which his behavior OF ATTITUDE
towards it is molded. Attitude is a way we perceive,
think, feel and react more or less permanently in  Attitudes are not innate–Attitudes are formed or
relation to something. learnt by the individual.
 Motivation and Emotional Processes 117
 Attitudes are more or less lasting–Attitudes are development of attitudes. These are parents,
enduring. peers, school, cultural norms, our motives, our
 Attitudes imply a subject-object relationship– emotional conflicts, mass media, etc.
Attitudes are always formed in relation to certain  Attitudes are formed in the context of the indi­
persons, groups or institutions. So, attitudes are vidual’s wants, information, group affi­liation
not just internal factors without any relationship and responsibility development. The individual
to the environment. in trying to satisfy his wants, develops attitudes.
 Attitudes are related to images, thoughts and He develops favorable attitudes towards people
external objects–For example, upon hearing of and objects satisfying his wants. He develops
the Pakistan attack on Indian territory, every unfavorable attitudes towards persons and
Indian developed a negative attitude towards objects that block the satisfaction of his wants
the Pakistan aggressors. In this the attitude and prevent him from achieving his goals. What
involved is the thought that by attacking India, attitudes we select for adoption depends on our
Pakistan has made a most unjustified and needs, our motivations and personality that we
immoral move. In this attitude some imaginary have formed.
concepts concerning the Pakistan aggressors are  Family is the first place for formation of attitudes.
present in the mind of the individual and these Parents are exceedingly important in the
are based upon his knowledge of the Pakistan formation of attitudes. They control rewards and
attack. Because of this attitude, the individual is punishments. Their smiles are a sign of approval
persuaded to contribute a portion of his wealth to and their frowns a sign of disapproval of behavior
the national defense fund in order to help expel of the child. It is the parents who establish the
the aggressor from the country. initial categories of good and bad. Their approval
 Attitudes guide the behavior of the individual and disapproval of certain activities lays the
in one particular direction–For example, due to foundation for the formation of favorable and
negative attitude towards the Pakistan aggressors unfavorable attitude towards that activity in the
the individual was prepared to do his best to child. Attitudes shape the information to which
help the Indian soldiers who were fighting the individual is exposed. The parents are the
them. Since, attitudes direct the activities of sources of information to the child regarding the
an individual, his reaction can be predicted by social and national groups, regarding religion,
knowing his attitudes. rules of conduct, rules of thinking, etc.
 Various kinds of affective experiences are also  Group affiliations help in the formation of
attached to attitudes. individual’s attitudes. The peer group is a
 The unconscious motive is an important factor very important source of attitude formation.
in the creation of attitudes. Sometimes even the Especially the young people learn the attitudes of
individual himself is unaware of the motive for their peer groups in order to be accepted by them.
his attitude towards a particular person or object Attitudes originated in the family are further
because it is in his uncons­cious. strengthened when they are apprecia­ted by peers
 Attitudes are related to the person’s needs and and playmates.
problems.  Attitudes are also influenced by mass media, e.g.
newspapers, journals, books, movies, etc.
FORMATION AND DEVELOPMENT  Many of our attitudes are acquired by us as a
result of the pressure from others or may be the
OF ATTITUDE outcome of some experience. For example, if you
 Heredity may play only a very small part in have had an unhappy experience in a hospital
the development of attitude. It is mainly the your attitude towards hospitals in general will be
environmental factors that are responsible for negative.
118 Psychology for Nurses

 Attitudes may be formed as a result of learning. may become abnormal, if he forms a wrong
This is the process of growing up and learning. attitude towards himself. For the individual’s
For example, male supremacy may be developed behavior to be desirable, his attitude towards
inside a house when much attention is given to himself and external objects should be favorable.
sons than to daughters.  Attitudes are our expressions of the likes and
 Attitudes may also be formed as a result of dislikes towards the people and the objects. They
experiences. Experiences become more distinct determine or guide our behavior in social situations.
and patterned as we grow up. One example for  An individual’s entire personality structure and
this is education, we can develop attitudes that behavior may be thought of as organized around
are favorable when we experience success in a central value system comprised of many related
school or when we realize how much society attitudes.
values education. The major reason for studying attitudes is the
 Through a single traumatic experience, we expectation that they will enable us to predict a
may also develop attitudes. Molested children person’s future behavior. In general, attitudes have
may feel bad when given something that re- been found to predict behavior best when:
minds them of the person who molested them.  They are strong and consistent: Strong and
 Also, attitudes may be formed through imitation. consistent attitudes predict behavior better than
This is done by imitating ready-made attitudes or weak or ambivalent ones. When the affective
prejudiced attitudes towards things. Racism is an and cognitive components of an attitude are not
attitude that some people imitate from others. consistent, ambivalence and conflict can arise
from within the individual. It is often difficult to
predict behavior. In general, when the components
BEHAVIOR AND ATTITUDE of an attitude are clear and consistent, they better
predict behavior. For example, when we like
 Attitudes are the motivating forces behind man’s
some­thing that we know is bad for us–it is often
social behavior. It is because of attitudes that
difficult to predict the behavior.
the individual’s behavior exhibits consistency.
 They are specifically related to the behavior
In the absence of a permanent organization
being predicted: For example, in one study
the individual would be a new person in every
students were asked about their general and
situation. For example, if an individual has a
specific attitudes towards nuclear war. Specific
negative attitude towards communism he will
attitudes were much better predictors of activist
always be seen opposing the communist party.
behavior such as writing a letter to a newspaper
 Attitudes also influence the individual’s abnormal
or signing a petition than mere general attitudes.
behavior. For example, some people believe in the
(Newcomb, Rabow and Hernandez, 1992).
existence of ghost, witches, etc. Consequently they  They are based on the person’s direct experience:
develop specific attitudes towards certain objects Attitudes based on direct experience predict
and because of these attitudes they indulge in many behavior better than attitudes formed from
kinds of religious rituals. reading or hearing about an issue.
 An individual not only formulates attitudes  The individual is aware of his or her attitudes:
towards external objects, but possesses atti­ There is evidence that people who are more
tudes even about him. These attitudes are very aware of their attitudes are more likely to behave
important for his social adjustment. His behavior in ways that are consistent with those attitudes.
 Motivation and Emotional Processes 119

ATTITUDINAL CHANGE ens their image of themselves as decent, kind,

honest, specially if there is no way they can ex-
Once the attitudes have been formed they have a plain away this behavior as due to external cir-
tendency to persist or continue. It is therefore difficult cumstances. There are ways to reduce, lessen
to change the attitude that has been established. But or minimize cognitive dissonance. One can add
it is necessary to modify un­ healthy or irrational or change beliefs. One can add a new belief or
attitudes for learning new things. In order to change change the old one he/she is holding so as to
attitudes we should– make it consistent with the behavior he/she is
 Change perceptions by new experiences and holding.
factual knowledge. Provide information to the  Counterattitudinal advocacy, a process by which
person concerned, who has a negative attitude individuals are induced to state publicly an opin-
towards the object/person; provide infor­ ion or attitude that runs counter to their own
mation that contradicts the attitude without any private attitudes. For example, you can help
comments, suggestion, persuasion, etc. It allows smokers change their attitude towards smoking
the person to take a decision himself, without by letting them make a speech about the negative
pressure, on his own and this may lead to a more effects of smoking.
favorable attitude towards the object/person  Self-perception theory says that first, we observe
concerned. and perceive our own behavior and then change
 The group support for the change should be our attitude.
obtained.  Although these dissonance techniques are power-
 Provide an opportunity for much closer contact ful, they are difficult to carry out on a mass scale.
with the object/person concerned. Let the person In order to change as many people’s attitudes as
learn through it and modify his own attitude. possible, one can use persuasive communication.

Health Education and Attitude Change PSYCHOMETRIC ASSESSMENT OF

Health education means imparting knowledge and MOTIVATION, EMOTIONS AND
information in order to achieve and maintain health. ATTITUDES
Teaching helps the patient to cope with disease. Very
often attitudes interfere with health and well being
Psychometric Assessment
of the patient. The initial step of the health educator
of Motivation
is to eradicate negative attitudes that the person may
hold towards himself, his illness and his future life. The important methods used to measure moti­vation
Through health education cognitive component of an are projective techniques, personality inventories
attitude is altered leading to emotional component and situational tests.
being altered parallely.
Projective Techniques
FACTORS AFFECTING ATTITUDINAL Most commonly used projective technique to measure
CHANGE motives is Thematic Apperception Test (TAT). In this
test subjects are shown a series of ambiguous pictures
 Attitudes can be changed through reducing cog- and asked to narrate a story about what is going on in
nitive dissonance. Cognitive dissonance is a state each picture. The assumption is that while narrating
of unpleasant psychological tension that moti- stories, the subject projects his or her own needs into
vates us to reduce our cognitive inconsistencies the behavior of the character. The psychologist then
by making our beliefs more consistent with each identifies the needs being projected and judges from
other (Atkinson et al, 1990). People experience the number of related items in the story how strong
dissonance when they do something that threat- each need is.
120 Psychology for Nurses

Personality Inventories Attitudes cannot be directly observed, but are

These are pencil and paper questionnaires made up inferred from overt behavior, both verbal and non-
of true-false or multiple choice questions about a verbal. Attitudes can be measured by the following
person’s habits, likes and ambitions. For example, tools:
Edwards Personal Preference Schedule—measures
human social needs, Taylors Manifest Anxiety Opinion Surveys (Public Opinion Polling)
Scale—measures anxiety level. and Self-report Methods
These surveys are concerned with replies to specific
Situational Tests questions in which people are asked to respond to
In this test subjects are put into a real situation and questions by expressing their personal evaluations.
an observer sees what they do. For example, a child’s The answers to such questions are separately
aggressiveness can be measured by letting it play tabulated in an effort to identify sources of particular
with dolls and observing the number of times he is opinion.
aggressive or does something destructive with them. In the self-report method a questionnaire or a list
of statements related to the attitudinal objects are
Psychometric Assessment of Emotions given to the respondent. The response format is either
fixed, i.e. categories for the responses are named
Measurement of emotion is important in under­ such as agree-disagree, like-dislike, favorable-
standing the physiological basis of emotion. The unfavorable; or left open ended where respondents
following methods are used to measure emotions: can use their own words.
Galvanic skin response (GSR): This test measures
the activation of sweat glands during emo­ tional Attitude Scales
arousal resulting in lowering of electrical resistance Attitude scales generally yield a total score indicating
of the skin. the direction and intensity of an individual’s attitude
Electrocardiography or electrocardiogram: This test towards an object, event or class of stimuli, e.g.
measures changes in the rate and rhythm of the heart Thurstone attitude scale, Likert scale, Guttmans
during emotional arousal. scalogram and Osgood’s semantic differential type.

Electroencephalogram (EEG): This test measures the Voluntary Behavioral Methods

brain rhythmic activity during emotional arousal.
In these the physiological measures are used. Earlier
Other tests: It include recording changes in muscle GSR and size of the pupil of the eye have been used
tension, breathing rate and BP during emotional as the indicator of arousal to measure attitudes.
arousal. These have not been very successful as only
extremity of attitudes can be measured and that too
Psychometric Assessment of Attitudes the direction of attitude cannot be specified. Recently
electromyography recordings from the major facial
Measurement of Attitudes muscles have been used to measure attitudes, but this
Attitude is measured through attitude scales like has not been successfully established.
the Likert scale, the semantic differential and the
sociometry. These scales attempt to measure how ALTERATIONS IN EMOTIONS
one person or a group feels about one thing. The
DURING ILLNESS
most commonly used among these is the Likert scale.
In this scale, the respondent is asked a question and People react differently to illness. Individual’s
answer using any of these: strongly agree, agree, do emotional reactions depend on the nature of the illness,
not know, disagree or strongly disagree. the patient’s attitude towards it, the reaction of others
 Motivation and Emotional Processes 121
to it, patient’s perceptions of illness, visibility of position to assess the psychological reactions of the
symptoms, availability of support system, economic patients. They can understand their emotional needs
variables and patient’s coping skills. Short-term, and plan for appropriate nursing interventions.
non-life-threatening illness evokes few emotional
changes. Severe illness, particularly one that is life Spend time with Patients
threatening can lead to more extensive emotional ™™ Listen while the patient is describing his feelings.
reactions such as anxiety, shock, fear, anger, denial ™™ Try to identify what is frightening to the patient
and depression. and offer appropriate explanations.
 Anxiety: Anxiety is a feeling of apprehension,
uneasiness, agitation, uncertainty and fear that Facilitate verbalization of feelings: Allow the patient
occurs when individuals anticipate threats. In to explore his emotions/feelings. Verbalization often
some individuals, anxiety is due to fear of a brings about a tremendous relief of tension.
possible diagnosis or impending surgery, etc.
 Worry: A mild form of anxiety characterized by Handling the Emotions
preoccupation of a problem. Common anxiety  Verbalization of distress is often accompanied by
producing factors in the hospital environment tearfulness. Many women get great relief from
are separation from significant others, lack a good cry. Men should not be denied too, it is
of privacy, lack of understanding of hospital just a manifestation. Any cry should be handled
language, strange sights, sounds, odors, etc. with care and privacy and support given until
 Fear: An emotional state characterized by expected composure is regained.
harm or unpleasantness.  Show acceptance of the patient’s behavior even,
 Shock: When patient or families are informed if the anger is directed at the nurse.
of a severe or life, threatening illness, shock  Try to determine the cause for anger and then
responses may occur. They hear what has been deal with it as realistically as possible.
said to them, but fail to respond or respond in a  Recognize that a patient using denial protects
totally inappropriate manner. himself from something he does not wish to face.
 Denial: Denial is a mechanism by which the  Deal with denial carefully and in cooperation
patient or family avoids emotional conflict and with other health personnel.
anxiety by refusing to acknowledge difficult  Try to help the patient find ways to cope with
facts. For example, a family knowing that their depression, such as engaging in some activity.
loved one has cancer may deny the diagnosis  Show respect for the patient’s feelings.
and attempt to continue as though nothing were
wrong. Short-term denial can be an effective way Orientation of Patient to Health Care Facility
of coping with an illness. Provide detailed explanation of the patient care
 Anger: An emotional state characterized by feelings services and of rationale behind various medical and
of frustration and struggle with a threatening or nursing procedures that the patient has to undergo,
unpleasant situation. Anger also may have effects with constant reassurances all along. This will
on patient’s social or spiritual dimensions. alleviate the fear of unknown in patients.
 Depression: An emotional state characterized
by a dejected mood. Depression occurs due to Identification of Learning Needs of Patients
absence of cure, loss of personal control.
Learning needs of patients have to be identified.
For example, a patient before surgery may worry
Nursing Interventions for Emotional about prognosis, pain, ambulation, dependency, etc.
Reactions Imparting knowledge on these aspects will satisfy
Nurses spend maximum time with the patients than patients need to know about his condition, treatment
any other hospital personnel and therefore, are in a and thus reduce anxiety.
122 Psychology for Nurses

Provide Diversional Activities role of primary, social, personal and unconscious

Encourage diversional activities within the motives in human behavior. She should understand
permissible limits of patient’s condition that are her own motives, so that she can better understand
pleasurable and tension reducing. Many chroni­cally patient motives.
™™ By an insight into the dynamics of motivation she
ill patients do not recognize their need for recreation.
Offer praise in a sincere and appropriate manner as can maintain her mental health and stay cheerful.
™™ Knowledge about physiological needs such as
the patient makes progress towards indepen­dence.
hunger and sleep, etc. help her in the physical
care of the patient.
Taking Care of Insomnia, Food and Fluid In-
™™ Knowledge of psychological needs give her an
take, Elimination Pattern
insight into how to use them favorably for cure.
 Employ measures such as low environmental ™™ It gives her an insight into the etiology of
stimuli, light meals in the night, engaging in day the patient’s behavior, thus leading to better
time activities, reading books, listening to music understanding.
at bedtime to promote sleep.
 Nurses need to assure adequate fluid intake and Understanding motives in a patient helps the
nutrition. Many patients in depression have little nurse in the following ways:
™™ To recognize motive behind the behavior of the
interest in food and their nutritional status can
patient.
decline sharply. Offer food of good nutritional
™™ To recognize patient’s needs and desires.
quality. Offer small attractively served portions
™™ To build a good relationship between the patient
frequently, allow enough time for the patient to
and the health team members.
consume it.
™™ To provide priority care (i.e. meeting primary
 Ensure regular elimination pattern, consti­pation
needs before meeting other needs).
is a common complaint in distressed patients.
™™ To satisfy patient needs.
™™ To promote healing and health in the patient.
Maintain Cheerfulness and Humor
Knowledge of the human needs assists nurses in
Human emotions can be contagious, hence patients responding therapeutically to patient’s behavior and
tend to enjoy having persons who are cheerful and in understanding themselves and their own responses
yet professionally competent and sincere about their to needs. Human needs serve as a framework for
work. Humor can often relieve anxiety, stress and assessing behavior, assigning priorities to desired
anger and help to develop warm relationships when outcomes and planning nursing interventions.
used appropriately.
NURSING IMPLICATIONS OF EMOTIONS
Seek Help of Mental Health Professionals
The knowledge about emotions is important for a
Patients who experience serious and prolonged
nurse. Normally the patients are less self-controlled
disruptions in their lifestyles and in their relation­
because of their illness. They may be tense, irritable and
ships with significant others due to their illness and
unbalanced. Therefore, the nurse has to be very mature
emotional reactions, should know that psychiatric
and balanced in her behavior towards the patient.
interventions can offer relief. Nurses should provide
 The nurse has to substitute patient’s negative
information about the sources of mental health care
emotions by positive emotions. She has to replace
in community.
fear, depression and hatred by hope, courage and
NURSING IMPLICATIONS OF MOTIVES love.
 The nurse should avoid tensions at all costs; she
The nurse should know how behavior is moti­vated should develop a sound philosophy of life and
by different needs. The nurse should understand the learn self-control.
 Motivation and Emotional Processes 123
For above reasons a nurse requires knowledge of mental illness, epilepsy and venereal diseases may
emotions, their nature, dynamics and control. still be treated as outcasts.
In some cultures ill health is regarded as shameful
ATTITUDE DURING HEALTH and wicked. Children in particular may regard illness
AND ILLNESS as some form of punishment. As it is not uncommon
for people to adopt an attitude of guilt and shame
Attitudes related to health may be based on factual towards their own pain and suffering, they find it
information or misinformation, common sense or impossible to discuss the illness even with a doctor
myths, reality or false expectations. Attitudes usually or a nurse. While assessing the patient, the nurse
influence health behaviors; they can positively or needs to assess his beliefs and attitudes, which will
negatively affect a patient’s level of health. influence his receptivity to nursing and medical care.
As far as health is concerned there are favo­rable and Patient attitude to his own sex and the opposite sex, to
unfavorable attitudes, which determine the outcome of youth, adulthood and old age will all have a bearing
illness. Attitudes related to some illnesses are: on his relationship with staff and other patients.
™™ After brain damage one cannot become normal Nurses should understand patient’s attitudes
again. and values about health and illness, so that effective
™™ Chickenpox occurs due to the curse of Goddess. care can be provided. One of the great tasks of a
nurse is to grasp any opportunity to modify harmful
Attitudes Towards Treatment attitudes. Behavior resulting from negative attitudes
™™ Rural folk have a favorable attitude towards not only militates against reaching an early diagnosis
herbal and traditional medicines. of the disorder, but may severely and unnecessarily
™™ Christians have favorable attitude, towards disadvantage the sufferer by delaying the medical
modern medicine as they are westernized. and nursing intervention.
™™ Muslims have favorable attitude towards Unani
medicine as it is a part of Muslim culture. NURSING IMPLICATIONS OF ATTITUDE
™™ Those influenced by Gandhian thoughts have
Attitudes influence the behavioral responses of the
favorable attitudes towards naturopathy.
individuals. Importance of study of attitudes for
™™ Generally educated people have more favo­rable
nurses can be related to the following factors:
attitude towards allopathy system of medicine.
To most people illness comes as an unwelcome
intrusion into their lives. Potentially it denies them
Patient Care
their preferred pursuits and it may involve pain and  Any negative attitude towards race, commu­nity
discomfort. Despite this, some regard illness as a or a disease results in a prejudiced beha­vior that
challenge. Their efforts to overcome illness and affects the patient care. Many a times stereotypic
disability may lead to greater achievements. Some beliefs, which the nurse might have developed
people, on recognizing permanent impair­ ment of in earlier socio-cultural milieu may not be based
their lower limbs may compensate by engaging in on rational scientific reasoning. Due to these she
sports and activities where the use of their arms is at may behave inappropriately causing interference
a premium. Some people use a time of illness as an with her professional competence.
opportunity to develop new interests.  The nurse should recognize her attitudes and
Suffering helps many people find a new faith prevent them from interfering with nursing care.
in religion or discover a new purpose in life. In this  The nurse should try to understand patient’s
way illness can be viewed positively, even leading attitudes. Some of them enter the hospital with a
to great personal fulfillment. Some illnesses bear a positive attitude, while some of the patients enter
stigma despite the efforts of health education and with a negative attitude. These are the result of
attitude change. For example, people suffering with previous experience in the hospital. Because of
124 Psychology for Nurses

this a patient with negative attitude may not co- Effects of Attitudes on Meaningful
operate with health care personnel. Learning and Retention
 The nurse should try to find out the causes of It is being recognized that besides cognitive factors,
unfavorable attitudes and change them into positive or negative attitudinal bias has differential
favorable ones as they help in treatment and effect on the learning of controversial material.
recovery. A nurse can do this by providing With favorable attitude one is highly motivated
efficient care, better experience and give adequate to learn, put greater effort and concen­trate better
explanations where necessary. while analyzing new material. Negative attitude
 The nurse needs to develop and cultivate leads to a close minded view and hence learning
professional attitude, which will contribute to her is impaired. Attitude structure exerts an additional
success in the work. facilitating influence on retention that is independent
of cognition and motivation. A nurse with favorable
Formation of Attitudes of attitude on learning will be highly motivated to learn,
Peers or Juniors puts greater effort and concentrates better.
Senior nurses have a significant impact on the Thus, a nurse should be aware of the correct
formation of opinion concerning health related attitudes required in her profession. A list of correct
attitudes for a successful and efficient nurse, given
issues. These attitudes could be cultivated by other
by Kempf and Averill are:
peer nurses, student nurses and other hospital staff
™™ Ambition to do her task well.
associated in health care. One has to be careful that
™™ Conformity with the rules and regulations of the
the negative attitude of one person does not generate
profession for which she is preparing.
similar attitudes in the group. Her attitude should be
™™ Willingness to work and to work with effec­tive­ness.
in conformity with the rules and regulations of the
™™ Cheerfulness and optimism.
profession for which she is preparing. ™™ Interest in the problems and difficulties of other
people.
Acceptance of New Technology ™™ Cooperativeness, industriousness, respect for the
In the present times, many new innovations in opinion and judgment of others.
techniques, equipment and methods of health care ™™ Interest in increasing the fund of knowledge
delivery are taking place. Our attitudes can bias our underlying effective nursing care.
acceptance towards new technology and high profile ™™ Determination to grow professionally.
specialties. ™™ Maintenance of poise and self-control in all
professional situations.
Curriculum Planning ™™ Maintaining a consistent pride in their profession.
™™ Rising to the unexpected without undue panic.
While planning a new curriculum or in revising ™™ Determination to make the patient comfortable
an existing curriculum in educational courses one by giving attention to small details.
needs to identify the attitudes of students and the In order to succeed in her profession the nurse
teachers. Accordingly attitude change for altered should develop the above attitudes and change her
behavior patterns can be sought and incorporated former attitudes accordingly.
in the curriculum. For example, to plan a course on
acquired immunodeficiency syndrome (AIDS) one REVIEW QUESTIONS
may study the attitudes on the nursing care of the
AIDS patient. Misconception or areas, which need Long Essays
attitude change can be planned and incorporated. 1. Explain the theories of emotions. (Mar 2012)
This would enhance the competency in dealing with 2. Explain the concepts and theories of motivation.
AIDS patients. (Sept 2011)
 Motivation and Emotional Processes 125
3. Define motivation. Explain the social motives. 16. Define frustration and its sources. (Oct 2006)
(Mar 2011) 17. Clarify need drive and motives. (Apr 2006)
4. What is an emotion. Explain the theories of 18. What is frustration and conflict? Explain the sources
emotions. (Aug 2010) of frustration. (Apr 2006)
5. Explain the Maslow’s theory of motivation. 19. Explain Abraham Maslow’s theory of moti­vation.
(Aug 2010) (Apr 2006)
6. Distinguish between primary and secondary drives. 20. What are conflicts? Explain the different types of
Describe briefly the physiological drives that conflicts with examples for each. (2004)
determine our daily behavior. (Oct 2007) 21. Explain biological and social drives with one
7. Explain the concepts and theories of moti­vation. example for each. (2004)
(Oct 2007, Apr 2006)
8. What are motives? Classify the different motives. Short Answers
(2004)
9. What is motive? Classify motives. Describe in 1. Adaptation and coping. (Mar 2012)
detail about physiological motives. (Nov 2003) 2. Stress. (Mar 2012)
3. Social motives. (Mar 2012)
4. Biological motives. (Sept 2011)
Short Essays 5. Stress. (Sept 2011, Sept 2009)
1. Psychometric assessment of emotions and attitudes. 6. Personal motives. (Sept 2011)
(Mar 2012) 7. Frustration. (Aug 2010)
2. Theories of emotions. (Mar 2012) 8. Emotions and health. (Mar 2009)
3. Maslow’s need theory. (Mar 2012) 9. Types of emotions. (Mar 2009)
4. Types of conflict. (Mar 2012) 10. Explain the development of attitudes. (Sept 2009)
5. Stress and adaptation. (Mar 2012) 11. Hunger drive. (Oct 2007)
6. Explain two theories of emotion. (Sept 2011) 12. Conflict. (Sept 2011, Aug 2010, Oct 2007, Apr 2006,
7. Development of attitude. (Mar 2011) 2004, Nov 2003)
8. Conflict resolution. (Mar 2011, Mar 2009) 13. Need. (May 2007)
9. Coping with stress. (Mar 2011) 14. Conflict in motives. (Oct 2006)
10. Emotions and health. (Aug 2010) 15. Maternal drive. (Oct 2006)
11. Theories of emotion in brief. (Mar 2009) 16. Self-actualization. (Oct 2006)
12. Theories of motivation. (Mar 2009) 17. Social motive. (Apr 2006, Nov 2003)
13. What are the characteristics of emotions. (Mar 2009) 18. Motivational cycle. (Sept 2011, 2004, Nov 2003)
14. Discuss Maslow’s self-actualization theory .(Mar 2009) 19. Biological motives. (2004)
15. What is a motive? Explain the biological motives 20. Name the different types of conflicts. (2004)
hunger and thirst. (Sept 2009) 21. Approach-avoidance conflict. (Nov 2003)
 CHAPTER

Personality
5
Etymologically, the word personality has been TOPOGRAPHY OF PERSONALITY
derived from the Latin word ‘persona’. At first this
word was used for the mask worn by the actors  One of the most important characteristics of
personality is that it is a product of heredity
(Roman and Greek) in ancient times, to indicate to
and environment. A child though not born with
the audience whether they played the villain’s or the
a personality, develops the same in course of
hero’s role in a drama. Thus the mask gave the actor
continuous interaction with his environ­ ment.
his characteristic features.
The social and cultural factors as well as the
Personality is the total quality of an individual
various experiences influence the development
behavior as it is shown in the habits, thinking,
of personality.
attitudes, interests, the manner of acting and the
 Personality includes the cognitive, affective
personal philosophy of life. It is the totality of one’s
and psychomotor behaviors and covers all the
being. It includes physical, mental, emotional and
conscious, subconscious and unconscious also.
temperamental makeup and how it shows itself in
 It is specific and unique for each and every
behavior.
individual.
 It is not static, but dynamic in nature. Perso­nality
DEFINITIONS of an individual keeps adjusting itself to the
“Personality consists of the distinctive patterns environment on a continuous basis.
of behavior including thoughts and emotions that
characterize each individual’s adaptation to the TYPES OF PERSONALITY
situations of his or her life”. A type is a class of individual who shares a common
(Walter Mischel—1976) collection of traits together in an indi­vidual.
“Personality is the sum of activities that can be
discovered by actual observations over a long enough Hippocrates Classification
period of time to give reliable information”.
Hippocrates tried to classify all human beings into
(Watson)
four characteristic groups according to their tempera­
Personality refers to deeply ingrained patterns of ment as follows (Table 5.1):
behavior, which include the way one relates to,  Sanguine
perceives and thinks about the environment and  Phlegmatic
one self.  Melancholic
 (American Psychiatric Association—1987)  Choleric
 Personality 127
Kretschmer’s Classification Sheldon’s Classification
Kretschmer classified all human beings into certain Sheldon classified human beings into certain types
biological types according to their physical structure according to their physical structure and attached
(Table 5.2). certain temperamental characteristics to them as
given below (Table 5.3 and Figure 5.1).

Table 5.1: Hippocrates classification of personality Jung’s Classification

Type of Personality Temperamental Dr Karl G Jung proposes to classify all individuals
fluids in type characteristics into two main groups (Table 5.4 and Figure 5.2).
the body
There are very few people who are purely
Blood Sanguine Optimistic, happy, hopeful, extroverted or introverted. Most of us have qualities
accommodating and
of both these types; in other words, we are ambiverts.
light-hearted
Phlegm Phlegmatic Cold, calm, slow and
in­different
Allport Classification
Black bile Melancholic Sad, depressed, Allport classifies all individuals into two types viz
pessimistic, dejected, ascendants and descendents (Table 5.5 and Figure 5.3).
deplorable and
self-involved
Yellow Choleric Irritable, passionate,
bile strong, active, imaginative

Table 5.2: Kretschmer’s classification of personality

Personality type Personality characteristics
Pyknic (having Sociable, jolly, easy going
fat bodies) and good natured
Athletic Energetic, optimistic and
(balanced body) adjustable

Leptosomatic Unsociable, reserved, shy,

(lean and thin) sensitive and pessimistic
Figure 5.1: Sheldon’s three basic somato types

Table 5.3: Sheldon’s classification of personality

Name Description Characteristics
Endomorphic Person having highly developed viscera, but weak Easy going, sociable, affectionate and
somatic structure—fat, soft, round (like pyknic type) fond of eating
Mesomorphic Balanced development of viscera and strong somatic Craving for muscular activity, self-
structure—muscular (like athletic type) assertive, loves risk and adventure,
energetic, assertive and bold tempered
Ectomorphic Weak somatic structure as well as undeveloped Pessimistic, unsociable, reserved, brainy,
viscera—thin, long, fragile (like leptosomatic type) artistic and introvert
128 Psychology for Nurses

Table 5.4: Jung’s classification of personality

Extroverts Introverts
• The extroverts are intere­sted in the world around • The introverts are interes­ted in themselves, their own
them feelings, emotions and are unable to adjust easily to
social situations
• They are sociable, frien­dly, not easily upset by • Socially they are aloof and withdrawn
difficulties
• They are men of action rather than reflection • They are shy and reserved
• They are successful in adjusting to the realities • They prefer to work alone and avoid social contacts.
of their environment, are socially active and more They are inclined to worry and get easily embar­
interested in leaving a good impression on others rassed
• Their behavior is in­fluenced more by phy­sical • Introverts are persons who seek manifestation of their
stimulation than by their inner thoughts and ideas life through inner activities by going inward or dragging
up things from within themselves
• Politicians, social wor­kers, lawyers, insu­rance • Philosophers, scientists, writers, etc. fall in this
agents, sales­men, etc. fall in this category category

Figure 5.3: Allport’s classification—Ascendant

and descendent

Figure 5.2: Jung’s two basic types of personality or traits which are somewhere between these two
Table 5.5: Allport’s classification of personality
extremes.
Ascendant Descendant
Personality Types and Heart Disease
The ascendant type The descendant
tends to dominate a (submissive) person is Two specific behavior pattern types are known to be
situation inclined to be self-critical, associated with increased or decreased likelihood of
self-analytical and indecisive coronary artery disease (Table 5.6).
He is outgoing and is He is daydreaming and ™™ Type A personality
interested in the world withdraws from social or ™™ Type B personality
around him competitive situations
THEORIES OF PERSONALITY
‘Type psychologists’ assume that human DEVELOPMENT
personalities can be classified into a few clearly Developmental theories identify behaviors associ­
defined types. Our observation, careful and detailed ated with various stages through which individu­
measurements of personality traits show that this als pass, thereby specifying what is appro­priate or
assumption is wrong. We cannot classify people inappropriate at each deve­lopmental level. Nurses
only as tall or short, thin or fat, intelligent or stupid, must have a basic knowledge of human personality
sociable or unsociable. Most of us possess qualities development to understand maladaptive behavioral
 Personality 129
responses commonly seen in the mentally ill. Knowl­ The major theoretical approaches to unders­
edge of the appropriateness of behavior at each tand personality include trait theory, psy­choanalytic
deve­
lopmental level is vital to the planning and theory, learning theory and huma­ nistic theories
implementation of quality nursing care. (Table 5.7).

Table 5.6: Characteristics of type A and type B personality

Type A personality Type B personality
• Type A persons are hard-driving and competitive • Type B persons are quite the opposite. They
are easy going, non-compe­titive, placid and
unflap­pable
• They live under constant pressure, largely of their own • They bear stress easily. They are likely to
making. They seek recog­nition and advance­ment and take live longer than Type A per­sons
on multiple activities with deadlines to meet. Much of the
time they may function well as alert, competent, efficient
people who get things done. When put under stressful
conditions they cannot control, however, they are likely
to become hostile, impatient, anxious and disorganized

• Given a task to do, Type As’ tend to perform any task near • Type Bs’ work harder when given a deadline
their maximum capacity no matter what the situation calls
for. They work hard at arithmetic problems whether or not a
deadline is imposed

Table 5.7: Major theoretical approaches to personality

Theory Assumption
1. Dynamic Personality Theories Psychoanalytic theory assumes that much of human
• Psychoanalytic theory—Sigmund Freud motivation is unconscious and must be inferred indirectly
• Jung’s analytical psychology from behavior. This theory emphasizes stages in
• Adler’s individual psychology development, a conflict between pleasure seeking and
• Horney’s psychoanalytic interpersonal reality demands. It also suggests that sexuality is the
theory source for conflict and human growth
• Psychosocial theory—Erikson

2. Humanistic Theories—Personality as the Self Humanistic theories of personality are concerned with the
• Roger’s self-theory individual’s personal view of the world, self-concept, and
• Maslow’s self-actualization theory push towards growth or self-actualization

3. Type and Trait Theories of Personality The basic assumption of the trait theories is that individual
• Type theories—Eysenck’s hierarchial theory personalities can be described in terms of a limited
• Trait theories number of dimensions
• Allport’s theory

4. Learning and Behavioral Theories of Social learning theory assumes that personality
Personality differences result from variations in learning experiences.
• Dollard and Millers early social learning Responses may be learned through observation
theory without reinforcement, but reinforcement is important
• Skinner’s radical behaviorism in determining whether the learned responses will be
• Bandura and Watsons—later social learning performed. Emphasis is on situation-specific behavior
theory rather than on broad characterizations of personality
across diverse situations
130 Psychology for Nurses

Despite the short comings of each of the major Sigmund Freud (1856–1939) an Austrian neurologist
perspectives on personality theory each point of is considered as the father of psychoanalytic theory
view has enlarged our understanding of human (Figure 5.4). He emphasized the unconscious
behavior. Psychoanalysis broadened our aware­ness processes or psychodynamic factors as the basis
of the continuity between infant and the adolescent. for motivation and behavior. Freud categorized his
Learning theory provided insight into how behavior personality theory according to structure, dynamics
is acquired, maintained and extin­guished. Humanistic and development. Freud organized the structure of
theory enlarged our hori­zons by emphasizing human personality into three major components: the id, ego
strivings towards self-fulfillment and growth. and superego (Figure 5.5).

PSYCHOANALYTIC THEORY

Figure 5.4: Sigmund Freud—Founder of psychoanalytic Figure 5.5: Freud’s components of personality: Id, ego and
theory superego

Figure 5.6: Functioning of personality components

 Personality 131
The id contains all our biologically based drives, Dynamics of Personality
it operates according to the ‘pleasure principle’. Id  Freud believed that ‘psychic energy’ is the force
driven behaviors are impulsive and may be irrational. or impetus required for mental func­ tioning.
The ego functions on the basis of ‘reality principle’. Originating in the id, it instinctually fulfills
It maintains harmony between the external world, the basic physiological needs. As the child matures,
id and the superego. The superego is referred to as psychic energy is diverted from the id to form the
the ‘perfection principle’. The superego is important ego and then from the ego to form the superego.
in the socialization of the individual as it assists the  Psychic energy is distributed within these three
ego in the control of id impulses (Figure 5.6). personality components, largest share to maintain
A person who is well-adjusted or mentally a balance within id, the impulsive behavior and
healthy, has all three components of personality. the idealistic behavior of the superego. If an
Freud would expect anyone in whom any of the excessive amount of psychic energy is stored in
component is absent or out of balance to display
maladaptive behaviors. Defense mechanisms have
been associated strongly with Freud’s theories.
One of the Freud’s main beliefs is that behaviors
resulting from ineffective personality development
are unconscious. He believed that ineffective
personality development was in some way related
to the relationship of the child with the parent and
that it was related to what he called psychosexual
development. Figure 5.7: Freud’s structure of personality

Figure 5.8: Freud’s stages of personality development

132 Psychology for Nurses

one of these personality components, behavior conscious and preconscious, content in the
will reflect that part of the personality. For unconscious remain inaccessible for the most
instance, impulsive behavior will prevail when part.
excessive psychic energy is stored in the id.  The unconscious affects all the three perso­nality
 Overinvestment in the ego will reflect self- structures—id, ego and the superego. Although
absorbed or narcissistic behaviors and an excess the id’s content resides totally in the unconscious,
within the superego will result in rigid, self- the superego and the ego have aspects in all the
deprecating behaviors. three levels of consciousness (Figure 5.7).
 The human personality functions on three levels  Some ideas, memories, feelings or motives
of awareness: conscious, preconscious and which are disturbing, forbidden and un­acceptable
unconscious. and anxiety producing are re­ pressed from
 Consciousness refers to the perception, thoughts consciousness. The process of repression itself
and feelings existing in a person’s immediate is unconscious and automatic, it just happens
awareness. without our knowledge. This repressed material
 Preconscious content on the other hand, is not continues to operate underground and converts
immediately accessible to awareness. Unlike the repressed conflicts into disturbed behavior

Table 5.8: Freud’s stages of personality development

Successful task
Stage of Examples of unsuccessful task
Main characteristics completion
development completion

Oral Use mouth and tongue to deal with Oral gratification Smoking, alcoholism, obesity,
Birth–2 years anxiety (e.g. sucking, feeding) nail biting, drug addiction,
difficulty in trusting others
Anal Muscle control in bladder, rectum, Bowel and bladder Constipation, perfectionism,
2–3 years anus provides sensual pleasure; control obsessive compulsive disorder
toilet training can be a crisis
Phallic Learn sexual identity and Becomes aware of Homosexuality, transsexuality,
3–7 years awareness of genital area as a sexuality sexual identity problems in
source of pleasure; conflict ends general, difficulty in accepting
as child represses urge and authority
identifies with same sex parent.
The development of electra
complex and oedipus complex
occurs during this stage of
development. Freud described this
as the child’s unconscious desire
to eliminate the parent of the same
sex and to possess the parent of
the opposite sex

Latency Quite stage in sexual development Learns to socialize Inability to conceptualize; lack
7–11 years of motivation in school or job
Genital Sexual maturity and satisfactory Sexual maturity Frigidity, impotence, premature
11 years– relationships with the opposite sex ejaculation, unsatisfactory
adulthood relationships
 Personality 133
and un­explained signs and symptoms. According task. For example, in the infant stage, the infant
to Freud this repressed material is also respon­ must learn to develop basic trust (the positive
sible for some of our dreams, accidental slips of outcome) such as that he or she will be fed and
tongue, etc. taken care of. The formation of trust is essential:
mistrust, the negative outcome of this stage, will
Freud’s Stages of Personality impair the person’s development throughout his or
Development her life (Table 5.9 and Figure 5.10).
Freud described formation of personality through
five stages of psychosexual development (Table 5.8
and Figure 5.8).

THEORY OF PSYCHOSOCIAL
DEVELOPMENT
Erik Erikson (1902–1994) (Figure 5.9) was a German
psychoanalyst who extended Freud’s work on
personality development across the life span while
focusing on social and psychological development
in the life stages. In his view, psychosocial growth
occurs in sequential phases and each stage is
dependent on completion of previous stage and life Figure 5.9: Eric Erikson—Founder of psy­cho­social theory

Figure 5.10: Erikson’s eight stages of psychosocial development

134 Psychology for Nurses

Table 5.9: Erikson’s eight stages of psychosocial development

Stage and Virtue Task Positive resolution Consequences of
approximate ages unsuccessful task
completion
Infant Hope Viewing the world Sense of security Suspiciousness, trouble
Trust vs Mistrust as safe and reliable, with personal relationships
Birth–18 months relationships as
nurturing, stable and
dependable
Toddler Will Achieving a sense of Sense of Low self-esteem,
Autonomy vs Shame control and free will independence dependency (on
and doubt substances or people)
1–3 years
Preschool Purpose Beginning development Balance between Passive personality,
Initiative vs Guilt of a conscience learning spontaneity and strong feelings of guilt
3–6 years to manage conflict and restraint
anxiety

School age Comp­­- Emerging confidence Sense of self- Unmotivated, unreliable

Industry vs Inferiority etence in own ability confidence
6–12 years taking pleasure in
accomplishments
Adolescence Fidelity Formulating a sense of Unified sense of Rebellion, substance
Identity vs Role self and belonging self abuse, difficulty keeping
confusion personal relationships.
12–18 years May regress to child play
behaviors
Young adult Love Formulating adult, Form close Emotional immaturity, may
Intimacy vs Isolation loving relationships and personal deny need for personal
18–25 years meaningful attachments relationships relationships
to others
Middle adult Care Being creative and Promote well Inability to show concern
Generativity vs productive; focus is being of others for anyone, but self
Stagnation on establishing family
25–45 years and guiding the next
generation

Maturity Wisdom Accepting responsibility Sense of Has difficulty, in dealing

Ego integrity vs for one’s self and life satisfaction with with issues of ageing and
Despair life, well lived death; may have feelings
45 years–death of hopelessness
 Personality 135

HUMANISTIC APPROACH Rogers (Figure 5.11) emphasized that each of us

interprets the same set of stimuli differently, so there
In contrast to the pessimism of the psychodynamic are as many different ‘real worlds’ as there are people
perspective, the humanistic approach opti­mistically on this planet (Rogers, 1980).
argues that people have enormous potential for
personal growth. When personality development Self-actualization
focuses upon the development of self, it is called
Carl Rogers used the term self-actualization to
humanism. Humanists like Carl Rogers and Abraham
capture the nature underlying the tendency of humans
Maslow reject the internal conflicts of Freud’s view
to move forward and fulfill their true potential. He
and the mechanistic nature of behaviorism. They
argued that people strive towards growth even in less
believe that each person is creative and responsible,
favorable surroundings.
free to choose and each strives for fulfillment or self-
actualization.
Personality Development
Humanistic theories emphasize the impor­tance
of people’s subjective attitudes, feelings and beliefs Carl Rogers proposed that even young children need
especially with regard to the self. Carl Rogers theory to be highly regarded by other people. Children also
focuses on the impact of disparity between a person’s need positive self-regard to be esteemed by self as
ideals, self and perceived real self. Maslow focuses well as others. Rogers believed that everyone should
on the significance of self-actualization. be given unconditional positive regard, which is a
non-judgmental and genuine love without any strings
Rogers Person-Centered Approach attached (Figure 5.12).

Maslow’s Hierarchy of Needs

 One of the basic themes underlying Maslow’s
theory is that motivation affects the person as a
whole, rather than just in part. Maslow believed
that people are motivated to seek personal
goals, which make their lives rewar­ ding and
meaningful.
 Abraham Maslow suggested that five basic
classes of needs or motives influence human
Figure 5.11: Carl Rogers (1902–1987)—Major behavior. According to Maslow, needs at the
humanistic theorist lowest level of the hierarchy must be satisfied

Figure 5.12: According to the humanistic view of Carl Rogers, people have a basic need to be loved and respected. If you
have unconditional positive regard from others, you will develop more realistic self-concepts, but if the response is condi-
tional it may lead to anxiety and frustration.
136 Psychology for Nurses

before people can be motivated by higher-level Therefore, they accurately reflect the distinc­
goals (Refer Chapter 4 – Page No. 98 for details). tiveness or uniqueness of his/her personality.
 Allport was deeply committed to the study of
TRAIT AND TYPE THEORIES OF individual traits. He started calling them as
PERSONALITY ‘personal’ dispositions. Allport proposed that
there are three types of personal dispositions.
“Personality is the dynamic organization within a. Cardinal disposition: A cardinal disposition is
the individual of those psychophysical systems so dominant that all actions of the person are
that determine his/her unique adjustments to his guided by it. Very few people possess cardinal
environment”. (Gordon Allport—1937) dispositions. For example, Ms Nightingale
Two major themes underlie trait and type theories whose actions were driven by compassion for
of personality: people.
™™ No two individuals are alike b. Central disposition: These are not as dominant
™™ People possess broad predispositions or traits to as cardinal dispositions, but they influence the
respond in certain ways in diverse situations; what person’s behavior in a very prominent way.
this suggests is that people display consistency in Therefore, they are called the building blocks of
their actions, thoughts and emotions across time, personality. For example, a person may have such
events and experiences. central dispositions as punctuality, responsibility,
attentiveness, honesty, loyalty, etc.
Gordon Allport’s Theory (1937) c. Secondary disposition: These are not very
 Allport’s (Figure 5.13) theory asserts that no two consistent and are thus less relevant in
individuals are alike. Allport regarded ‘traits’ as reflecting the personality of the individual.
being responsible for these individual differences. For example food and clothing preferences,
Accor­ding to Allport, trait is a predis­position to specific attitudes, etc. may be considered as
act in the same way in a wide range of situa­tions. secondary dispositions.
 Allport distinguished between common traits and
individual traits. Common traits are shared by Raymond Cattell’s Theory (1965)
several people within a given culture. Individual  Cattell spoke of the multiple traits that comprise
traits are peculiar to the person and do not the personality, the extent to which these traits
permit comparisons among people. They guide, are genetically and environ­mentally determined
direct and motivate an individual’s adjustment. and the ways in which genetic and environmental
factors interact to influence behavior.
 According to Cattell, personality is that which
permits us to predict what a person will do in
a given situation. In line with his mathematical
analysis of personality, prediction of behavior can
be made by means of a specification equation:
R= f (S, P)
According to this formula the response (R) of
the person is a function (f) of the stimulus (S)
at a given moment of time and of the existing
personality structure (P). This equation conveys
Figure 5.13: Gordon Allport’s (1897–1967)—Exponent Cattell’s strong belief that human behavior is
of trait and type theories of personality determined and can be predicted.
 Personality 137
 Traits are a major part of Cattell’s theory, personality questionnaire (EPQ). It covers items
which he defined as the individual’s stable and from each of the personality types identified by
predictable characteristics. him.
 Cattell divided traits into surface traits and source  Throughout his writings, Eysenck consistently
traits. Surface traits are not consistent over time emphasized the role of genetic factors and
and do not have much value in accounting for neurophysiological factors, role of the cerebral
the individual’s personality. Source traits are cortex, autonomous nervous system, limbic
the basic building blocks of personality which system, reticular activating system (RAS) in
determine the consistencies of each person’s explaining individual differences in behavior.
behavior over an extended period of time.  Cattell and Eysenck have been called as factor
 Basing on extensive research, Cattell identified analytic trait theorists.
sixteen source traits that constitute the underlying
structure of personality (such as outgoing- LEARNING THEORIES OF PERSONALITY
reserved, stable-emotional, self-sufficient-group
dependent, etc.) He con­structed a scale to measure These theories emphasize the importance of learning
these source traits, which came to be known as and objectivity to understand personality.
‘Sixteen Personality Factor Questionnaire’ (16
PF Questionnaire). Dollard and Miller’s Learning
Theory of Personality
Hans Eysenck’s Theory (Trait-type This theory emphasizes the development of
theory of Personality) personality on the basis of the responses and behavior
Personality is more or less stable and enduring learnt through the process of motivation and reward.
organization of a person’s character, temperament, This theory stressed the habit formation through
intellect and physique, which determine the unique learning as a key factor in the development of
adjustment to the environment. (Eysenck)
 The essence of Eysenck’s theory is that the
elements of personality can be arranged Table 5.10: Eysenck’s trait-type theory of personality
hierarchially. In this scheme certain super traits Emotionally Stable Emotionally Unstable
and types such as extroversion exert a powerful I
Passive Quiet
influence over behavior. N
Careful Pessimistic
 Accordingly, Eysenck’s focus has been on a T
R Thoughtful Unsociable
small number of personality types, defined Peaceful Sober
O
by two major dimensions: introversion-extro­ V Controlled Rigid
version, stability-instability (neuroticism). E Reliable Moody
Even-tempered Anxious
 Based on these personality types, Eysenck R
T Clam Reserved
proposed four separate categories of people
(Table 5.10). E Sociable Active
X Outgoing Optimistic
 Later on, he added a third type of dimension T Talkative Impulsive
to personality called as psychoticism-superego R Responsive Changeable
strength. People belonging to this category O Easy-going Excitable
are selfish, impulsive and opposed to social V Lively Aggressive
customs. E Carefree Restless
R
 Basing on his categorization of personality types, Leader-like Touchy
T
Eysenck constructed an inventory called Eysenck
138 Psychology for Nurses

personality. Habits are formed by stimulus response ™™ It is also helpful for an individual to assess his/her
connections through learning. As one’s fund of own personality so that he/she can better under­
learning grows on the basis of experiences and stand himself/herself and others, choose a career
interaction with one’s environment, one’s habits are wisely and therefore, find greater happiness in life.
reorganized, new habits are learned and consequently As personality is a complex thing and it varies from
one’s personality is modified and developed in terms person to person, it is very difficult to form a correct
of learning new behavior and picking up new threads idea of one’s personality by one method or technique.
or styles of life. There are a number of procedures and techniques
that are being used for proper evaluation.
Bandura and Walter’s Social The following methods are commonly used for
Learning Theory evaluation and measurement of personality traits:
 Interview method
Albert Bandura and Richard Walters (1963) came
 Observation method
out with an innovative approach to personality in the
 Personality inventories (rating scales and ques­
form of their social learning theory. They advanced
tionnaires)
the view that what an individual presents to the
 Projective techniques
world at large as his personality, is acquired through
 Situational tests
a continuous process of structuring and restructuring
of experiences, gathered by means of social learning
and later imitated in corresponding situations Interview Method
(Figure 5.14) (Refer Chapter 3—Page No. 50 for Interview can be defined as a face to face conver­
details). sation carried on with some basic goals. Two broad
types of interview are: structured and unstruc­tured
PSYCHOMETRIC ASSESSMENT interview.
In ‘structured interview’ predetermined questions
OF PERSONALITY are asked for which answers are also highly specific.
Assessing means to measure or evaluate. Methods of ‘Unstruc­tured interview’ is an open interrogation. Here
assessing personality are very important because: the interviewer questions or lets the individual speak
™™ They provide a means for studying personality. freely so as to get a clear picture of the individual.
™™ It is often helpful, for example, to be able to From what he/she says, the interviewer knows about
assess personality for the purpose of employ­ment his/her interests, pro­blems, assets and limitations.
or selection for education. Interview is a highly flexible tool and can be used
with a wide variety of population. The person can be
observed for body language in addition to what is said.
Interview method has been criticized for being highly
subjective. The results can get influenced by the personal
qualities of the interviewer. It is time consuming and
at times costly. This method requires a well trained
and competent person to conduct the interview. An
interview must be long and comprehensive to give a
true picture of the individual’s personality.
The seven-point plan (Roger, 1974) is possibly
one of the most widely known formats for job
interviewing. It provides a framework within which
interviewers can work and suggests the following
areas; should be explored in the context of matching
Figure 5.14: Social learning theory the candidate with a job.
 Personality 139
 Physical characteristics or abilities which are ‘True’ or ‘False’ or ‘Cannot say’ to 550 statements
important to the job, for example, good health, about different personality traits such as attitudes,
vision, hearing and speech. emotional reactions, physical and psy­ cho­logical
 Attainments which include education, personal symptoms. The answers are quanti­tatively measured
and professional background and an assessment and personality assessment is done based on the
of how well the candidate has done in these areas. scores.
 Overall general ability, especially general Personality questionnaires are used in psy­chology
intelligence and cognitive skills. for counseling and for research purpose. They are
 Special aptitudes; though desirable at an also used in selection process for employment or
interview for selection to nursing the social skills promotion. Some examples of questions used in
are important. personality inventories or questionnaires are given in
 Interests and how they are pursued which Table 5.11.
are occupationally significant, for example,
intellectual, physical and social pursuits. Projective Techniques
 Personality attributes such as self-perception, Projective techniques are based on the principle that
reliability, sociability. responses to unstructured stimuli reveal a subject’s
 Circumstances which might be important in underlying motives, attitudes, fears and aspirations.
relation to the person’s life and aspirations. In projective tests an individual is presented with
a relatively unstructured or ambiguous task like a
Observation Method picture, inkblot or incom­plete sentence, which permits
In this method the individual is observed in various a wide variety of interpretations by the subject. The
situations (such as observing a person at work or basis of assump­tion underlying projective tests is
play) for several days and some con­ clusions are that individual’s interpretation of the task will project
formulated. Direct observation is most accurate if the the characteristic mode of responses, the personal
observers are well trained in this activity. motives, emotions and desires and thus enable the
One of the disadvantages of observation is the examiner to understand more subtle aspects of the
possibility of prejudice in the observer. Evaluation by personality.
observing can be made more accurate and objective The most commonly used projective techni­ques
if the observer uses a list of behavioral traits as a are:
guide and rates the person on a scale. Having more ™™ Rorschach inkblot test
than one observer helps to improve accuracy and ™™ Thematic apperception test
prevents bias in making assess­ments. ™™ Word association or free association test
™™ Sentence completion tests
Personality Inventories
Table 5.11: Personality questionnaire
A personality inventory is a printed form containing
Questions Answers
statements, questions or adjectives which apply
to human behavior. The subject indicates his/her 1. Do you adapt yourself Yes No
easily to new conditions?
reactions to the various items and then the test is
scored and evaluated. Relative to other assessment 2. Do you have frequent ups Yes No
and downs in mood?
procedures, inventories are less time consuming and
easy to administer, but in some cases the subject can 3. Do you usually take the Yes No
initiative in making new
create a false impression about himself if he wishes
friends?
to do so.
One of the most commonly used personality test 4. Do you prefer to work Yes No
alone rather than with
is the ‘Minnesota Multiphasic Personality Inventory’ people?
also called the MMPI. This test asks for answers of
140 Psychology for Nurses

Rorschach Inkblot Test response. Based on subject response the examiner

It was developed by Herman Rorschach in 1921. This evaluates the individual’s personality. In this test
test involves ten cards containing inkblots shown to people were read a standard array of 100 terms for
the subject one at a time in a prescribed order. The example, ‘head’, ‘to sin’, ‘to pray’, ‘bride’, ‘to abuse’
subject is instructed to state whatever he/she sees and instructed to respond to each term as quickly as
in them or whatever they bring to mind. Based on possible with the first word that occurs to subject’s
subject’s statement, assumptions are made on the mind.
nature of the personality (Figure 5.15).
Sentence Completion Test
Thematic Apperception Test In this, a number of incomplete sentences are given
This test was developed by CD Morgan and Henry and the subject is required to complete them. For
A Murray in 1935. The assumption underlying the example, often I feel I am ………….
Thematic Apperception Test is that the meaning The subject is required to complete the sentence
which we see in a picture reveals something of our as he or she feels and the responses are analyzed for
past experience, feelings, attitudes and motives. indications of one’s personality. A basic problem
In this test, subject is shown ambiguous pictures with these tests is that the interpretation of response
and asked to make up a story for each one. The is very subjective and based on the experience of the
themes in these stories are likely to involve conflict, examiner.
affection, fear, contentment or achievement assumed The sentence completion tests are considered
to be determined partly by the subject’s underlying superior to word association because the subject can
concerns (Figure 5.16). respond in more than one word and so it becomes
possible to have great flexibility and variety of
Word Association Test responses as a result of which a wider area of
personality and experiences may be revealed.
In the word association test the subject is informed
that the examiner would utter a series of words, one
word at a time and subject should immediately utter
Situational Tests
the first word which comes to his mind and that there Situational tests consist of certain real life situations
are no right or wrong answers. The examiner then where the subjects have to perform certain given
records the reply to each word spoken by him/her,
the reaction time and any unusual speech or behavior
manifestations which might accompany a given

Figure 5.15: An inkblot of the type used in the Rorschach test Figure 5.16: A sample picture from TAT
 Personality 141
activities. Subject’s performance and behavior with depressed and try to close themselves off from their
respect to such situations helps us to understand surroundings. All these increase their loneliness and
his/her personality. In this test, subject’s behavior feelings of rejection.
is evaluated by some trained judges. For example, a Illness may weaken a patient’s feeling of security.
child’s aggressiveness can be measured by letting it The factors which cause insecurity are delayed
play with dolls and observing the number of times he diagnosis and uncertainty of recovery, strangeness of
is aggressive or does something destructive with them. place and people surrounding him, change of daily
routine.
ALTERATIONS IN PERSONALITY
DUE TO ILLNESS Changes in Self-concept, Body Image
and Lifestyle
Illness is a highly personal state in which the
persons physical, emotional, intellectual, social, Certain illnesses can change the patient’s body image
developmental or spiritual functioning is thought to or physical appearance, especially severe scarring or
be diminished or impaired compared with previous loss of a limb or a special sense organ. These patient’s
experience. self-esteem and self-concept may also be affected.
How people behave when they are ill is highly Self-concept is important in relationship with
individualized and affected by many variables such other family members. A patient whose self-concept
as age, sex, occupation, socio-economic status, changes because of illness may no longer meet
religion, ethnic origin, psychological stability, family expectations, leading to tension or conflict.
personality and mode of coping. As a result the family members may change their
Behavioral changes associated with short- level of interaction with the patient.
term illness are generally mild and short lived. An Illness imposes a certain amount of restriction
individual may become irritable resulting in lack of on the patient regardless of his age, socio-economic
energy or desire to interact with family members or status or profession. Normal activities have to cease
friends. More acute responses are likely with severe for some time, normal interests and responsibilities
life threatening, chronic or disabling illness. have to be given up.

Common Behavioral Changes due Self-centeredness

to Illness The individual experiencing illness gets too
™™ Withdrawn behavior personal. The threat posed by illness typically causes
™™ Changes in self-concept, body image and lifestyle the patient to become preoccupied with himself and
™™ Self-centeredness his health. The individual notes the changes in him
™™ Demanding and dependent behavior and show much concern about his illness. As the
™™ Uncooperativeness seriousness of an illness increases even less attention
™™ Hostility is paid to the outside world or the concerns of others.
™™ Shame and guilt feeling He finds himself to be important and tries to be more
careful about his health every time. Self-centeredness
Withdrawn Behavior interferes with quick recovery.
Illness, particularly long-term or severe may
cause patients to withdraw. Regardless of whether Demanding and Dependent Behavior
patients are in a hospital or at home, they may Many patients tend to regress to a more childish level
avoid interaction, remain in their rooms or resort to of behavior as a reaction to illness. This shows a
solitary activities. They may become apathetic and behavior of adult patients who are highly demanding
142 Psychology for Nurses

or anxious or excessively dependent on others. Nursing Interventions

Adult patients who seem to be afraid by taking the  Nurses need to help patients express their
treatment and react timidly are also regressed. thoughts and feelings and to provide care that
helps the patient effectively cope with change.
Uncooperation  Feelings of insecurity can be lesser by straight
Individuals react to illness in many different forward explanations of hospital conditions and
ways. Some patients are uncooperative and show procedures including details of routine by being
reluctance towards health care. Patients who do not warm and reassuring in her manner and through
follow advice of their caregivers are often labeled as sincerity of personal interest in the patient.
resistive or non-compliant or un­cooperative. Some  Withdrawn patients need gentle encourage­ment
times such patients fail to enter a treatment program to talk, to express feelings and relate to the nurse.
or they drop out. Often they do not keep follow-up or Nurse should spend time with these patients even
referral appointments. At other times uncooperative in silence, as it increases their sense of worth.
patients do not take prescribed medications or they  Explore the reasons for anxiety and commu­
do not alter their lifestyles or activities. The mutual nicate clearly.
effort towards recovery becomes a tug of war  Convey an enthusiastic readiness to care for
between the nurse and the patient. the patient. Failure to do so often aggravates
dependent or demanding behavior.
Hostility  Patient’s negative feelings must be replaced by
Hostility is the type of aggression that is oriented feelings of hope, courage and willingness to
to cause purposeful harm because of anger or cooperate.
provocation. Patient may be angry about the  Nurses have to build-up healthy personal rela­
helplessness of the situation; unfair fate, etc. Hostility tionships that are the relationship of confidence
may in many circumstances be inwardly directed and cooperation with the patient.
by persons having feeling of worth­ lessness and  Patient should not be allowed to regress,
manifest itself in self-deprecating and self-punishing but should be encouraged to participate in
behavior. recreational activities individually and in groups.
 Nurses should find out the reasons for anger and
stop it right in its track.
Shame and Guilt Feelings
 The nurse can help the patient verbalize his
When patient believes that their illness is a feelings and perceptions about his problems. With
punishment for sin or wrong doing (either imagined verbalization anxiety subsides and behavioral
or real), he may react with feelings of shame and problems reduce.
guilt. Certain diseases may make an individual feel
disgraced or ashamed depending upon his family
ALTERATIONS IN PERSONALITY DUE TO
and cultural background. Some people feel that they
shamed their family by having certain unacceptable PERSONALITY DISORDERS
conditions, for example, mental disorders, venereal Personality disorders result when personality
diseases, epilepsy, etc. They may feel unrealistically traits become abnormal, i.e. become inflexible and
responsible for having brought on the condition; maladaptive and cause significant social or occupational
such feelings of shame and guilt related to illness are impairment or significant subjective distress.
damaging to the self-concept. The definition of abnormal personality given by
Illnesses that are socially unacceptable, for International Statistical Classification of Diseases
example, communicable diseases, AIDS, etc. cause and Related Health Problems—9th revision (ICD9)
the patient to be rejected. is as follows:
 Personality 143
“An abnormal personality is one in which there maintain consistent, responsible functioning at work,
are deeply ingrained maladaptive patterns of behavior school or as a parent.
recognizable by the time of adolescence or earlier and Individuals with ‘histrionic personality disorder’
continuing through most of adult life. Because of this, characteristically have a pervasive pattern of
the patient suffers or others have to suffer and there is excessive emotionality and attention seeking
an adverse affect on the individual or on society.” behavior and are drawn to momentary excitements
and fleeting adventures.
Classification of Personality Disorders
Individuals with ‘narcissistic personality
™™ Paranoid personality disorder
disorder’ are self-centered, self-absorbed and lacking
™™ Schizoid personality disorder
in empathy for others. He typically takes advantage
™™ Dissocial (Antisocial) personality disorder
of people to achieve his own ends and uses them
™™ Histrionic personality disorder
without regard to their feelings.
™™ Narcissistic personality disorder
™™ Borderline personality disorder ‘Borderline personality disorder’ is marked by a
™™ Anxious personality disorder pattern of instability in interpersonal relationships,
™™ Dependent personality disorder mood, behavior and self-image.
™™ Obsessive compulsive (Anankastic) personality
‘Anxious personality disorder’ is marked by
disorder
feelings of inadequacy, extreme social anxiety, social
The exact cause of personality disorder is
withdrawal and hypersensitivity to others opinions.
unknown; most likely, they represent a combination
People with this disorder have low self-esteem and
of genetic, biological, social, psychological, devel­
poor self-confidence; they dwell on the negative and
opmental and environmental factors.
have difficulty viewing situations and interactions
objectively.
Clinical Features of Abnormal
Personalities ‘Dependent personality disorder’ is characterized
by an extreme need to be taken care of, which leads to
Individuals with ‘paranoid personality disorder’ are
submissive, clinging behavior and fear of separation
marked by a distrust of other people and a constant
or rejection. People with this disorder let others make
unwarranted suspicion that others have sinister
important decisions for them and have a strong need
motives. Persons with paranoid personality disorder
for constant reassurance and support.
search for hidden meanings and hostile intentions in
everything others say and do. ‘Obsessive compulsive (Anankastic)’ personality
disorder is marked by a pervasive desire for perfection
‘Schizoid personality disorder’ is characterized
and order at the expense of openness, flexibility and
by detachment and social withdrawal. People with
efficiency. The individual places a great deal of
this disorder are commonly described as loners,
pressure on himself and others not to make mistakes.
with solitary interests and occupations and no close
May have a constant sense of righteous indignation
friends; typically they maintain a social distance
and feelings of anger and contempt for anyone
even from family members and seem unconcerned
who disagrees with him, believes his way of doing
about other’s praise or criticism.
something is the only right way, may force himself
‘Antisocial personality disorder’ is characterized and others to follow right moral principles and to
by chronic antisocial behavior that violates others conform to extremely high standards of performance
rights or social norms, which predisposes the affected and insist on literal compliance with authority and
person to criminal behavior. The person is unable to rules.
144 Psychology for Nurses

Personality disorder is often difficult to treat. and demanding. A warm, sincere outlook can help
Drug treatment has a very limited role and may be them out.
used if associated with mental illness like depres­sion
or psychosis. Individual and group psychotherapy, REVIEW QUESTIONS
therapeutic community and beha­vioral therapy may
be beneficial. Manipulation of the social environment Long Essays
can be tried. 1. Define personality. Explain any one theory of
personality development. (Mar 2012)
APPLICATIONS 2. Define personality and theories of personality.
(Sept 2011)
An understanding of personality will help the nurse to 3. Define personality. Explain Freud’s psychoanalytic
predict her behavior as well as the behavior of others. theory. (Mar 2011)
Major decisions in life depend upon this knowledge. 4. List out types of personalities. Discuss in detail
For example, selection of a career, spouse, etc. her about Freud’s theory of personality. (Mar 2009)
relationship with friends and relatives depend upon 5. Write an essay on different types of per­sonality.
(May 2007)
her expectations of their behavior by understanding
6. Elucidate factors influencing the development of
their personalities. personality and its characteristics. (Oct 2006)
The nurse should not only acquire skills and 7. Define personality. Discuss the determinants of
knowledge, but also develop a pleasing and strong personality. (Apr 2006)
personality if she should be successful. Patients, 8. What is personality? Explain any three theories of
doctors, coworkers and other important members of personality with its evaluation. (2004)
the society want certain behavior patterns and certain 9. How is personality assessed? What are the different
qualities from them. In particular, patients appreciate types of personality? (2004)
a nurse who brings physical comfort to them with 10. Explain the trait theory of personality. Discuss
the various trait compositions necessary to have
her skills and who is prepared to understand their
effective nurse-patient relationship. (2004)
emotional reactions and difficulties which have been 11. What are the personality changes due to illness?
caused by illness.
Besides possessing such professional quali­ties as Short Essays
integrity, dignity, mental alertness, self-confidence,
1. Types of personality tests. (Mar 2012)
caring attitude, empathy, app­ roachability, respect
2. Assessment of personality. (Aug 2010, Mar 2009)
for the patient, ability to build trust and accepting
3. Discuss Freud’s theory of psychosexual
the patient as he is, she ought to have such personal development. (Mar 2009)
qualities as sympathetic understanding, friendliness 4. What effect does acute illness have on perso­nality?
of spirit, gracious manner, kindliness, adaptability, (Oct 2007)
genuineness, optimism, sincerity and self-awareness. 5. Role of questionnaire in personality assess­ ment.
Besides these qualities mentioned above, good (Oct 2007)
health, fresh and neat appearance, a strong purpose 6. Discuss various trait compositions necessary to have
and will power, a high standard of values, healthy effective nurse-patient relationship. (Oct 2007)
work habits, sense of humor, teaching as well as 7. Briefly describe the organization of perso­nality.
(May 2007)
managerial abilities and the ability to control one’s
8. Personality traits and an ideal nurse. (Oct 2006)
emotions and have healthy and friendly interpersonal 9. Discuss the personality traits of an effective teacher.
relationship are important traits that the professional (Apr 2006)
nurse should cultivate. 10. Briefly describe the organization of perso­nality.
The nurse deals with different age groups. A good, (Nov 2004)
sensitive nurse should be aware of their personality. 11. Explain the importance of personality in nursing.
A sick person is very emotional, sensitive, dependent (Feb 2004)
 Personality 145
12. What is the nature of personality? What factors 3. Trait. (Mar 2011)
contribute in development of personality? 4. Projection. (Apr 2008)
(Nov 2003) 5. Introverts. (Oct 2006)
13. What are projective tests? Explain their role in 6. Development of personality. (Apr 2005)
personality assessment. (Nov 2003) 7. Physical traits. (Apr 2005)
8. Social traits. (Apr 2005)
9. What are “traits” and “types”? (2004)
Short Answers
10. Give two examples for projective tests of personality.
1. Id. (Mar 2012) (2004)
2. Ego. (Sept 2011, Mar 2012) 11. Superego. (Nov 2003)
 CHAPTER

Developmental
Psychology 6
This branch of psychology describes the processes development resulted from maternal deprivation. There
and factors that influence the growth and development is strong evidence that very small children suffer from a
in relation to the behavior of an individual from birth sense of loss, mourning and grief when away from their
to old age. It is further subdivided into branches mothers (Robertson, 1970; Howthorn, 1974). At first
like child psychology, adolescent and adult and the child may be fearful or angry; later there is a stage
old age psychology. Development psychologists of resignation with lack of interest and an apparent
try to understand complex behaviors by studying inability to accept love or return affection. How much
their beginning and the orderly ways in which they this affects the child’s development and his/her ability
change or develop over the lifespan. to form relationships with other people later on in life,
depends to some extent on the nature and duration of
PSYCHOLOGY OF PEOPLE AT DIFFERENT the separation from his/her mother and on the mother
AGES FROM INFANCY TO OLD AGE child rela­tionship before separation (Clarke and Clarke,
1976). Rutter (1981) argues that the concept ‘maternal
Infancy deprivation’ has been used to cover a wide range of
different childhood experiences, which have different
The period of infancy begins with birth and lasts
effects on development.
for 1 year. The infant is called a neonate for the first
On admission to hospital, children experience
4 weeks after birth. During the first 12 months the
many other distressing events, for example, the fact
infant shows very rapid motor development and
of being ill, strange medical and surgical procedures,
learns to sit, stand and begins to walk. Infant weight
different daily routines and a variety of unknown
triples from birth weight by 1 year. Length increases
people. Nearly always, the child’s rate of progress
by almost 50 percent from birth.
both physically and mentally is affected when there
Psychological needs of an infant: It include need for is lengthy or repeated separation from its mother. On
security, love, affection, warmth, comfort, accep­ returning home the child may refuse to recognize his/
tance, nourishment, understanding and physical her mother and remain detached and unres­ponsive for
contact. The infant needs to be cuddled and fondled sometime. Bowel or bladder control achieved earlier
frequently and recognized consistently. might be lost. There may be excessive clinging,
nightmares and other emo­tional disturbances.
Children in Hospital
Very small children cannot bear to be separated from Role of a Nurse
parents for long. Bowlby (1951) argued strongly  The nurse who is to take care of infants must
that disturbances in mental health and personality realize that the primary task of an infant is to grow.
 Developmental Psychology 147
The growth and development of an infant is all Other important achieve­ments during this period
round—physical, mental, social and emotional. are learning how to use writing tools, identifying
The nurse who works with infants should give letters, numbers and sounds.
as much personal atten­tion as possible such as He/she experiences emotions of love and hate,
handling, cuddling, holding and loving. This jealousy and anxiety. He/she also learns to tolerate
kind of care will prevent deprivation and promote a certain degree of frustration and disappointment
healthy physical and emotional development. and deal with his/her own difficulties independently.
 Accurate observation of the infant is extremely Thus it is a period of rapid physical, intellectual and
important as the infant cannot communicate its socioemotional growth.
needs through speech. Cry is the infant’s main
method of communication. Restless movements Psychological needs during childhood: It include
of body parts are another way in which the infant love, recognition, security, acceptance, encourage­
communicates its needs. ment, protection, discipline, nutrition, etc.
 The nurse should know that the infant may cry Older children, once they have recovered from
when it is hungry, in pain, diaper is wet or feels an acute phase of illness, enjoy the com­panionship
uncomfortable for any reason. in the ward. During illness a certain amount of
 The nurse should very closely observe infant’s regression may occur. For example, the child
growth and development for any abnor­malities. behaves in a manner more appropriate to a younger
 The nurse should also be aware of normal age. The nurse needs to recognize and help the child
individual differences in an infant’s development. to return to a more mature behavior. Child should
 It is important for the nurse to accept the infant as not be penalized or insulted for wetting the bed or
a unique individual. resorting to baby talk.
 Encourage parents to comfort the infant and also
involve them in providing care. Role of a Nurse
 During care use sensory soothing measures. For  Tender loving care and physical security continue
example, stroking the skin, talking softly, giving to be important to the child during these years.
pacifier, cuddling and hugging the child. The  It is important that children’s routine in hospital
child should be given love, affection and care. resembles normal life as far as possible. The
 The surroundings of the child should be pleasant child’s day should be a well-established routine,
and cheerful. which includes a right time for play, stories, bath
 Child should be given suitable toys to play with. and for rest.
⓫ The use of force and violence should be avoided  Accurate observation is important to find out any
in dealing with the child. physical or emotional problems.
 A cordial relationship should be established with
Early Childhood (2 to 6 Years) the young patient by talking to him at his own
The growth rate slows down in most areas during level such as asking him his, nickname and likes
this period. The average child becomes two and one- and dislikes.
half inches taller and 5 to 7 pounds heavier during  Provide love and affection.
each year of early childhood.  The nurse should be patient in dealing with children.
The child during this period learns to walk,  The child should be encouraged to develop a
run, climb, jump and balance; he/she develops fine spirit of independence.
motor skills and muscular coordination. He/she also  Allow the child to participate in care and to help
develops sensory perception of size and learns to whenever possible (for example, drink medicine
speak. He/she is capable of practical thinking and from a cup, hold a dressing).
solving simple problems. Learns how to dress and  Explain the procedure in simple terms and in
care. relation to how it affects the child.
148 Psychology for Nurses

 Give choices whenever possible but avoid exces­ children appear to associate the nurse’s uniform
sive delays. with the unpleasant experience of sickness and pain.
⓫ Praise the child for helping and attempting to The child’s early experiences with sickness, pain,
cooperate, never shame the child for lack of co- hospitalization, separation from his/her mother and
operation. being cared for by nurses may influence attitude to
⓬ Provide privacy from peers during procedure to sickness later in life.
maintain self-esteem.
⓭ It is desirable that the child acts independently Later Childhood (6 to 12 Years)
and does not remain in a dependent state for too
During this period physical growth is slow and
long. Encourage him to do things for himself.
gradual. The average child grows 2 to 3 inches in
⓮ See that the child does not remain worried,
height and gains about 3 to 5 pounds of weight in a
tense and moody or sad on account of being
year.
subjected to new, sudden and harsh changes
The increased muscular development and re­
such as unexpected separation from parents or
sistance to fatigue makes new skills and activities
preoperation fears.
possible. Children develop much smoother and well-
⓯ Opportunities for play should be provided. Allow
coordinated muscle move­ments during this age. They
the child to choose his/her own play if possible.
become capable of many muscular activities such as
Drawing or scribbling is excellent for the child;
running, swimming, riding a bicycle and throwing
picture books and puzzles are favored when the
or catching a ball. Writing or reading and the abil­
child is old enough. Through play, child may be
ity to handle language are two important achieve­
able to express frustration by projecting feelings
ments during this age. The child is now able to make
on its dolls.
the finer movements necessary for writing. His/her
⓰ Games and toys should be made available in
thinking is more stimulated by concrete objects and
the pediatric unit. If not, reading a story book or
situations, which can be seen. He/she cannot handle
educational material to the child is a pleasant and
complex arithmetic problems.
useful amusement.
⓱ Nurses can learn to use play therapeutically. Psychological needs during later childhood: It
includes love, affection, security, belonging needs,
Handling Parent’s Anxiety under­standing, attention and physical care, needs
Parents of sick children need to be helped too. They opportunities to exercise his/her muscles and to
may not behave very normally because of their acute refine his motor coordination. He/she also needs
anxiety. Some parents may become over-critical and protective environment, encouragement, discipline,
fault-finding. They become annoyed and resentful provision for self-expression, guidance and direction
when the nurse does not answer all their questions to to understand what behavior is expected.
satisfaction. A nurse should be sympathetic, tolerant
and tactful when dealing with their questions and Role of a Nurse
anxiety and not get upset or lose temper. There is a  Tender loving care and emotional support is
need to reassure parents and make them feel well and important if the child is experiencing lone­liness,
cheerful. pain or discomfort for any reason.
Small children do not understand the meaning  He/she needs guidance and direction to under­
of sickness very clearly. They cannot understand stand what behavior is expected of him or what
cause and effect, symptoms and treatment. They may the rules are when hospitalized.
blame the nurse or doctor for their pain. It may be  The older child should be given explanations for
necessary to separate the functions of the nurse so procedures and reasons for hospital rules and
that the nurse who gives the child his/her daily care policies. He/she may ask many questions, which
is never associated with causing him/her pain. Some the nurse must answer.
 Developmental Psychology 149
 Health teaching should include teaching, which the emotional as well as the intellectual activities of
is directly related to an illness or prevention the individual. Biological changes lead to moods,
of illness. Habits of personal hygiene should confusion and worries of all types.
be encouraged. Visual aids may be used while Puberty is the important physical change dur­
teaching. It is important to praise the child when ing adolescence. He/she becomes mature or capable
he is successful in his learning. of sexual reproduction. Endocrine glands regulate
 Observation of the child’s physical condition and puberty through the secretion of hormones. Adoles­
his behavior is important. Problems in emotional cent girls and boys become very interested in sexual
health may be reflected by signs of depression or development and relationships with members of the
sadness, withdrawal from others or lack of self- opposite sex.
control. An adolescent has many variations in mood,
 The intellectual development of the child can be variations between excessive bursts of energy and
evaluated by observing his/her ability to con­ periods of laziness. They are extreme sensi­tiveness,
verse and reason, read, write or solve arithmetic self-consciousness, desire to be intellec­tually and
problems. emotionally independent.
 Allow the child to participate in care and to help Psychological needs of an adolescent: It include
whenever possible. need for status, independence, satisfying philosophy
 Explain procedure in simple terms and in relation of life, a proper orientation to the opposite sex and
to how it affects the child. guidance in selecting a vocation.
 Allow the child to play. Word puzzles, jigsaw puz­
zles and quite games are pleasant and amusing. Role of a Nurse
The ambulatory child needs more physical exer­
cise and should be encouraged to walk.  Explain each procedure with scientific ratio­nale.
 The child will expect the nurse to share her Much explanation should be given about rules
policies and procedures as possible.
time and attention with him. It often may be a
 Because the adolescent has a rapidly changing
challenge for the nurse to be consistent and fair
body and is extremely self-conscious of this, it
as she relates with each one.
is helpful to provide as much privacy as possible
when care is given.
Adolescence (12 to 19 Years)  Encourage questions regarding fears, options and
Adolescence is a period of rapid physical, intellec­ alternatives.
tual, emotional and social growth—a period of  Discuss how nursing procedure may affect
growing up. Physically, the boy or girl becomes an appearance and what can be done to minimize it.
adult; sex organs mature. Adolescence begins with  Involve in decision making and planning (for
very rapid changes in the body. Changes can be example, choice of time, place, individuals
seen in height and weight, shape of the body, sound present during the procedure, etc.).
of the voice, presence of pubic and facial hair and  Accept regression to more childish methods of
other external sex characteristics. The initial spurt in coping. Adolescent may weep or become very
growth usually begins about 2 years earlier in girls emotionally upset when facing an injection or
than in boys. unpleasant treatment. They should be given extra
There is intellectual growth towards a more emotional support and loving care when this
abstract and mature mode of thinking. Intelligence happens.
reaches its maximum during this period. Emotionally,  Allow adolescents to talk with other adoles­cents
the adolescent grows independent of parents and who have undergone the same pro­cedure.
prepares himself for entering into other relationships  Adolescent will most likely be able to make
that are needed in marriage, work and in the commu­ decisions about caring for himself and planning
nity. Sex consciousness develops and this influences his health care for the future. In most cases,
150 Psychology for Nurses

he needs the parents to accord per­mission for  Young adults need teaching and assistance in
decisions, which involve ad­mission or discharge, handling the baby. The teaching should also
surgery or other major hospital procedures. include the importance of good nutrition,
adequate sleep, proper exercise and prevention
Early Adulthood (20 to 40 Years) of venereal diseases.
 Personality characteristics of the patient should
During early adulthood, most adults reach their full
be recognized and respected. The major task of
height. A number of sensory and neural functions are
the nurse is to respond to the different needs of
also at optimal levels during this period. For women, different personalities.
reproductive capacity is at its peak during young  Explaining procedures and what is expected
adulthood. Intellectual abilities appear to peak during of the patient will relieve anxiety. Answering
this period. Tasks requiring quick response time, questions about the diagnosis, treatment and care
short-term memory and ability to perceive complex also relieve anxiety.
relations are performed more efficiently during late  Assist the patient in solving problems about
teens and early twenties. Certain creative skills also which they worry.
reach highest level during young adulthood.  The ultimate goal of the nurse-patient relation­
Young women have additional psychological ship throughout adulthood is helping the patient
differences related to body changes. About 75 to achieve independence. Inde­pen­dence should
percent of all women in young adulthood experience be encouraged by the nurse as soon as the patient
mood swings with the cycle of menstruation. These is ready.
are believed to be caused by hormonal changes in the
body. Middle Adulthood (40 to 60 Years)
Choosing a career and life partner are top Middle adulthood, commonly called mid-life, brings
priorities in this age. Child rearing is usually an with it dramatic changes in physical development.
important part of young adulthood. The slow decline of physical development, which
During this period behavior is governed more begins during the late years of early adulthood
by intelligence than emotions, adults adapt easily appears to speed up and is much more visible as a
to social situations, face reality objectively, have person reaches the late forties.
normal drive to work or play and act according to In middle age, the skin looses some of the
own age. Adults are vocationally adjusted and are elasticity; hair begins to thin out and often turns
able to think and decide things on their own. grey or white. Muscular strength declines slowly,
but steadily, from young adulthood onwards. A
Psychological needs of early adulthood: It include a
very major physical change comes about in the
balance of intimacy, commitment, freedom and inde­
cardiovascular system of a person in middle life.
pendence. The adult too like the child and adolescent
The older heart cannot pump as much blood as the
needs security, self-realization and recognition. Oth­
younger heart. Coronary arteries supplying the heart
er needs are development of intimate relationships,
with blood begin to narrow. Cholesterol levels rise
marriage and status in the society.
and begin to collect on the walls of the arteries,
which are also beginning to thicken. Blood pressure
Role of a Nurse
usually rises during middle adulthood.
 Young adults are rarely hospitalized. When During middle adulthood, men and women
they are, it is usually for childbirth, injuries undergo a number of changes in their repro­ductive
from accidents or problems of the digestive or and sexual organs, a process that generally is referred
genitourinary system. Emotional support and to as the climacteric. These changes are linked
understanding will be of help for all parents to decrease in the production of sex hormones,
when childbirth occurs. specifically estrogen and testosterone. For women in
 Developmental Psychology 151
mid-forties cessation of menstruation occurs termed Late Adulthood (60 Years and Above)
as menopause. A number of unpleasant symptoms The age of 60 years and above is commonly
have been correlated with menopause, which include considered as old age. It is the period of retirement
profuse sweating, hot flashes, dizziness, headache, from active work. It is marked by impairment of
irritability, depression, insomnia and weight gain. sensory function (seeing and hearing). In general,
The male climacteric occurs at about 50 years of age, there is a slowing down of motor functions, besides
during which men experience a gradual decline in a gradual impairment in muscular coordination.
testosterone. The resistance to disease and injury diminish. Old
people also show a gradual decline in mental ability.
Role of a Nurse
Memory, attention, thinking and ability to learn new
 The middle-aged adult is most likely to be things are affected.
hospitalized for cardiovascular problems or Of all physical changes, a loss in the efficiency of
cancer. Higher blood pressure as well as high the cardiovascular system has the maximum impact
cholesterol level may be evident. Other common upon a person in late adulthood. Other chronic
health problems at this age are diabetes, peptic diseases, which are common among old age are
ulcer and communicable diseases. cancer, arthritis, loss of hearing and vision.
 When a middle adult is admitted in the hospital
he/she needs to feel welcome and secure. Explain Psychological needs of late adulthood: It include
hospital procedures and policies clearly. need for improvement of self-image, need for normal
 Anxieties apart from illness are experienced on roles and relationships, need for love and relatedness,
account of different kinds of responsibilities need to improve sense of hopefulness and need for
faced by the person. These include personal accomplishment of tasks.
anxieties about other family members, respon­
sibilities at home, possible loss of a job, etc. The Role of a Nurse
nurse needs to guide family members to help the  Older adults may be hospitalized more often than
patient in each of these areas. any other age group. Nursing care of the elderly
 Observation of emotional and physical health is is called geriatric nursing.
necessary to recognize signs of physical decline.  A special effort should be made to make the elderly
 Persons of this age need more lighting to see well person feel respected and valued as an individual.
or may need verbal directions repeated in order Insecurities and apprehensions should be relieved
to hear what is being said and to remem­ber what as much as possible by giving careful explanations
is being asked. Written instructions should be to the patient and the family members.
provided when needed.  Terminal illness is often a part of care for the
 The nurse should recognize signs of an inabi­ older adult. The nurses should be prepared to
lity to deal with stress at home, at work or in the give care and support as the patient prepares to
hospital, these signs are agitated body language, die. Allow the patient to express their emotions.
increased levels of vital signs, insomnia, irritabil­  The nurse should observe the patient’s ability to
ity or depression. hear and see, the ability to walk and check the
 Health teaching should include the prevention vital signs regularly.
and early diagnosis of most common diseases.  The elderly may not feel pain as readily as younger
 The nurse should help them to take care of people and bedsores can quickly develop even
themselves. All health care members should with regular nursing care. If a patient cannot move
encourage independence as soon as the patient is easily without help the various parts of the body
ready for it. should be exercised regularly with assistance.
152 Psychology for Nurses

 The older adult also needs close observation on PSYCHOLOGY OF VULNERABLE

behaviors such as depression, lack of interest in INDIVIDUALS
others or environment, withdrawing from others,
sleeping poorly, expressing des­pair or sadness. Psychology of Challenged Individuals
All these reflect an inability to cope with the  Chronic illness and prolonged disablement
changing life situation. necessi­tate a reconstruction of patient’s idea
 Elderly people often express a longing for the of himself and a complete reorganization of
warmth and personal touch of another person. relationships.
Emotional help and support from others are very  Patient who realizes that he is permanently
necessary in order for them to find the strength disabled becomes angry with himself and with
and inner resources to adapt to their changing others.
lives and lifestyles. Personal relation­­ships
 He may express anger towards the family
with others should be encou­raged. Encourage
members and towards the hospital staff.
appropriate activities such as playing games or
 He may refuse to meet people or to go out.
listening to music, entertainment, creative hand
 This phase of self-consciousness increases the
work, etc.
difficulties, like family members or hospital staff
 The elderly often need help to see well. Some
methods help the older adults to see well such feel embarrassed or discomfort due to patient’s
as reducing glare for reading, give extra-lighting attitude.
when possible, keep things near the visual field  When the patient first realizes that he cannot
and use large print or magnifiers. completely regain his original health condition
 Physical protection from harm and injury should he may become depressed.
be provided to the older person. This may include  He loses interest in himself and the surrounding
assistance in walking or moving, bedside rails and finds life not worth living.
especially at night and protection from tissue  He refuses to take sufficient nourish­ment,
injury when compressors or other skin applications treatment, neglects personal hy­giene and loses
are used. The elderly person is easily disoriented interest in all activities.
in a new environment and, if ambulatory, should  The will to live is essential to recover and the
be protected from becoming lost. nurses must help the patient to see that inspite of
 Health teaching should include personal hygiene, his handicap he is needed by those who love him
importance of exercise, good nutrition, etc. and that he can be useful to the community.
Teaching will be effective if pictures, diagrams  Some health conditions are progressive causing
and posters with large print can be used. dependence, disablement and suffering. The
⓫ The most effective way of teaching for this group patient may feel obligated to pretend that he feels
is to teach one thing at a time. The older adults optimistic in order not to cause pain to his relatives.
can learn new things if they are pre­sented in the ⓫ Some people who grow up with a disability
right way and related to what are familiar. (handicap) devote most of their time and energy
⓬ Anything completely new and different may in overcoming it and excelling in developing
have to be repeated at regular intervals to help skills, which are difficult to acquire. While a
the person remember. It is most helpful to relate few others cope with their disability by ignoring
new things to old things or old ideas whenever it and concentrating on achieving excellence in
possible. other areas.
 Developmental Psychology 153
⓬ The greatest isolation occurs in those who Depression
lose sight, speech or hearing. Sometimes this Women are twice as likely as men to experience de­
isolation may lead to confusion, disorientation pression. Psychological studies show that women tend
and a terrifying feeling of being lost leading to to respond to adversity by with­drawing and blaming
aggressive behavior. Blind people need constant themselves. In contrast, men tend to deny adver­
inter­pretation of their environment while they are sity and throw themselves into activities. Hormones
learning to use their other senses. It is important can create mood changes before menstruation (pre­
for the nurse to learn communication skills with menstrual tension) and after childbirth (postpartum
the deaf such as gestures, mime, writing and depression) or due to the use of oral contraceptives.
demonstration.
The nursing care and rehabilitation of the disabled Teen Pregnancy
must aim at helping the patient to acknowledge his
When an unwanted pregnancy occurs in this stage of
disability so that he can create a new idea of himself,
a woman’s life, it can significantly alter her eventual
which includes his handicap. emotional development. The nurse can help her
understand the options available and aid the use of
Psychological Needs of Women her own strengths to cope with the current situation.
Just as physical disorders affect women differently
than men, women’s psychological needs are different. Infertility
Also, some issues are specific to women. Infertility can be financially, emotionally and
Following are some examples: psychologically draining. Although infertility affects
both men and women, women often feel the loss of
Assertiveness not becoming pregnant and a psychological loss of
Many women have been raised to be passive and place not being a ‘real woman’. The nurse can help her
the needs of others before themselves. For example, to cope with the feelings of loss associated with
a woman, who is a wife and mother may define her infertility.
role as the giver and nurturer and disregard her own
emotional needs. She may reach a point where she Domestic Violence
begins to experience anxiety and depression as she More than 50 percent of women experience some
has lost her own self-identity. A nurse can help the form of violence from their spouses. This may occur
woman uncover her strengths and work towards in the form of verbal abuse, limiting behavior or
understanding her needs and goals. The nurse will actual physical attack. Emotional abuse is difficult
help her to become more assertive when addressing to identify and often leaves the victim with a
difficult interpersonal situations. sense of something wrong but doubting their own
perceptions. The abuser degrades her dignity and
Body Image self-worth and makes her feel worthless. The nurse
In today’s society there is a significant emphasis can help the woman re-establish her sense of self-
placed on body image. Through TV, magazine, worth and remove herself from the violent situation.
movies and other media young women receive a
distorted message regarding appropriate body image. Rape
Thus, women’s definitions regarding their own body Women who have been the victim of rape by a
may be distorted, resulting in eating disorders such stranger, date rape or family member often experi­
as anorexia nervosa and bulimia. Many women view ence a psychological effect known as rape trauma
their body with fear and loathing sometimes leading syndrome. Women experience low self-esteem or
to self-injury. The nurse should help her to develop a low confidence. There is a lot of self-blame and
positive body image. self-attack. Other common feelings are depression
154 Psychology for Nurses

and anger. It is important for women to process the family due to the additional burden in providing
feelings they have regarding the rape and resulting health care to the patient.
trauma with a qualified psychotherapist.
Psychology of Caregivers during Illness
Psychology of Sick Person Illness in an individual also leads to considerable
The main aim of nursing care is to assist the patient in emotional disturbance among relatives who may feel
attaining the highest possible level of independence. guilty about not observing symptoms earlier or not
Sickness interferes with self-care, interpersonal taking complaints seriously.
relationships, control over others, responsibilities If the illness is serious and the prognosis is
and obligations particularly if admission to hospital poor, the relatives fear for the patient’s life, which
is necessary. Inevitably illness results in disturbance is accompanied by anxiety about impending
of family and other social relationships. Illness also bereavement and doubt about their own ability to
affects the emotional component in the individual. cope.
Short-term, non-life-threatening illness evokes The emotional and financial strain of chronic
few emotional changes. Severe illness, parti­ illness often results in a secret wish for early death.
cularly one that is life-threatening can lead to more Such a wish is then followed by immediate regret
extensive emotional reactions such as anxiety, shock, and by attempts to compensate for the guilt feeling.
fear, anger, denial and depression. There may be Relatives need someone who can help them to see
anger about overwork, the hazards of the occupation, that such thoughts are normal and under­standable.
and about a dangerous lifestyle, which may be held When relatives can talk about their feelings they can
responsible for the illness. often continue to shoulder the burden of care. When
Communication problems among the patient and they cannot talk about their feelings they may detach
the family members may arise as they are not well themselves prematurely.
informed about the health issue. It is compounded For many the pain of witnessing deterioration in
when the doctors and nurses are not forthcoming due their loved one may be too much to bear. They mourn
to seriousness of the aliment or poor communication the loss of the perfect image of the person they loved.
skills. Such issues require considerable amount of By the time the patient dies their grief may already
time, repeated contact, privacy and intimacy. be spent.
Patients need the stimulation of news about
current events and of people in the outside world and Loss and Grief
visitors should be encouraged to give news rather Patients who are terminally ill are often aware of the
than ask for it. approach of death before anyone has dis­cussed the
The need to maintain family relationships and subject with them. Glaser and Strauss (1965) have
friendships during illness is important when small described three states of awareness that may surround
children are involved. Separation of children from the dying person and his family. These are closed
their parents can cause a lot of anxiety. If the child is awareness, mutual pretence and open awareness.
the patient, the presence of the mother or the primary In closed awareness the patient and his family
caregiver holds a lot of significance. When one of the may be unaware of the impending death and may even
parents is admitted in the hospital it is important that lack a full appreciation of the illness. It may be that
children should be allowed to visit them. the relatives know but have decided that the patient
During illness when patients remain at home should not be told. Conversely, the patient may know
they retain greater independence. Under such the truth but does not know if his closest relatives
circumstances the nurse’s job becomes all that more do. This creates problems for both the patient and his
challenging as the patient may more readily exercise family and a dilemma for the nursing staff who may
his right to deny care and forgo advice. Prolonged feel that the patient’s trust in them may be threatened
illness at home often results in the isolation of the by less than honest communications.
 Developmental Psychology 155
In mutual pretence the patient, his family and Stage V-Acceptance: The final stage brings a feeling
the caregivers know that the prognosis is mortal of peace regarding the loss that has occurred. Focus
but choose not to discuss the subject. Such mutual is on the reality of the loss and its meaning for the
pretence is often motivated by concern to protect individuals affected by it.
against distress but in reality may lead to a sense All individuals do not experience each of these
of discomfort and burden created by the absence of stages in response to a loss, nor do they necessarily
anyone in whom to confide. experience them in this order. In some individuals
In open awareness all concerned know the grieving behavior may fluctuate and even overlap
truth and feel able to acknowledge and discuss between stages. However, it is desirable to help the
the impending death. By doing so, the patient in patient to reach a state of acceptance rather than die
particular is able to express his needs and desires in despair. It may be essential to help the patient
and experiences a continuing sense of belonging through the earlier stages and encourage him to talk
and participating. It must be said, however, that about his feelings. The nurse has to cope with the
open awareness is not an easy option and many still emotions of dying patients and their relatives and
avoid it; some may feel able to discuss practical accept the feelings they express.
arrangements but need support and under­standing to
come to terms with their emotional responses. Mourning
Kubler-Ross (1969) having done extensive When death eventually occurs friends and relatives
research with terminally ill patients identified five go through a period of mourning. Grieving relatives
stages of feelings and behavior that individuals may feel at times an obligation to suppress their
experience in response to a real, perceived or fears, appear tolerant, calm and unaffected. Adult
anticipated loss: mourners sometimes feel that children should be
protected from discussions about death. Some
Stage I-Denial: This is a stage of shock and disbelief.
bereaved persons never establish a satisfactory life
The response may be one of “No, it can’t be true!”
for themselves after the death of spouse, parent
Denial is a protective mechanism that allows the or child. They continue a life that becomes pro­
individual to cope within an immediate time-frame gressively more isolated and depressed. Some may
while organizing more effective defense strategies. develop extreme hostility and resentment towards
Stage II-Anger: “Why me?” and “It is not fair!” are those with whom they were formerly associated
comments often expressed during the anger stage. through the deceased person. Especially in elderly,
Anger may be directed at self or displaced on loved the death of the remaining spouse may occur soon
ones, caregivers and even God. There may be a after bereavement.
preoccupation with an idealized image of the lost Worden (1983) described four tasks of berea­
entity. ved. These are accepting the reality, accep­ting the
pain that grief causes, adjusting to life without the
Stage III-Bargaining: “If God will help me through loved one and able to reinvest emotions in other
this, i promise i will go to church every sunday and relationships.
volunteer my time to help others”. During this stage, Nurses should be available to support the
which is generally not visible or evident to others, a bereaved. The nurse should know the duration of
bargain is made with God in an attempt to reverse or grieving process, if it is prolonged and unresolved it
postpone the loss. may result in physical and psychological problems.
Stage IV-Depression: During this stage the full
impact of the loss is experienced. This is a time Psychology of Groups
of quiet desperation and disengagement from all The basic unit of study in social psychology is the
associations with the lost entity. group, which is made up of two or more persons who
156 Psychology for Nurses

regularly relate with each other. Members of a group major social and cultural norms is called antisocial
are united by social relations. behavior. Norms include the social standards,
Group is defined as two or more people who customs, traditions and fashions.
influence one another through social interactions. Roles are behavior patterns expected from
 (Baron—1993) people in certain social positions. Society expects
certain behavior from those in certain roles. Each
Classification of Groups person in a society takes on different roles in daily
life and behaves according to the expectations of
Cooley CH classifies groups into three types:
other people. Our behavior changes as we change
 Primary group: In this type there is an intimate
our role. Almost all social situations are built around
face to face relationship and cooperation
roles. They mold the behavior of every person in a
between the members. All the members have a
society. Roles are useful because they help people
‘we’ feeling and are prepared to make maxi­mum
know what to expect from each other.
sacrifice for each other, for example, family.
Groups are crucial for the development of
 Secondary group: In this group the relationship
individuals and for some individuals changes in
is more or less casual. It is marked by a single
health are possible to achieve with group support
bond of interest. The example of this type of
and encouragement. The attitudes that individuals
relationship is found in professional organi­
have are developed in kin and friendship group;
zations, trade union groups, etc.
continued membership throughout life in other
 Tertiary group: In this type of group the degree of
groups influences thoughts, choices, behavior and
intimacy or relationship is for a short period and
values. People tend to find their social needs met
marginal in character. The audience in a cinema
through association with others and groups are a
hall or the passengers in a railway compartment
natural vehicle for these needs.
are examples of this type of a group.
Health behavior is influenced greatly by the
groups to which people belong and for which they
Influence of Group on Individual
value membership. The patterns and directions of
Behavior everyday activities are learned in a family and these
Groups influence their members in many ways, but are later reinforced or challenged by new sets of
such effects are often produced through culture, important others.
values, norms and roles. Each group develops its own standards of values,
Culture is a complex whole, which includes its own rules about behavior and its own attitudes
knowledge, belief, art, morals, law, custom and any to which members are expected to conform. When
other capabilities and habits acquired by man as a individuals fail to conform, the group as a whole
member of the society. Our behavior is molded exerts pressure to bring the member’s behavior
and controlled by the society and culture in which within the range of acceptable behavior. It has been
we are born. The most important parts of a culture, shown that groups are more efficient in solving
which are learned by each member of their group are problems than the individual members (Hoffman and
values, norms and roles. Clark, 1976).
Values are the ideals of group, which decide When a decision has been made by a whole
whether something is good or bad. These may group the members feel much more bound by the
include such standards as human dignity, edu­cation, decision than if it had been imposed on the group by
human rights or freedom. one person.
Norms are very closely related to values. If People in groups work together and have
we behave according to cultural norms we will be definite objectives and goals, in counseling, groups
approved by others in that culture, called conformity. are formed with specific goals and intentions. In a
The behavior of a person who refuses to confirm to group, performance is enhanced by mutual support.
 Developmental Psychology 157
Groups force people to conform to rules; conformity changing the thinking, attitude and feelings of group
behavior helps groups to work for attainment of members. Interaction with other members in the
group goals. group will help a patient to develop an insight and to
Certain factors, which help for better functioning overcome many feelings.
of a group are: group cohesion, group facilitation and
group morale. Group cohesion refers to uniformity REVIEW QUESTIONS
of opinion of its members. It is necessary for its
effectiveness. Group facilitation gives members a Long Essays
feeling of contentment. Group morale is a positive 1. Describe psychological needs at different age levels
group feeling of general satisfaction and enthusiasm —Role of a nurse.
for work. When group morale is high, the group 2. Describe psychological needs of patients—Role of
tends to be more active and productive. a nurse.

Group Therapy Short Essays

In group therapy several unrelated people meet with 1. Vulnerable individuals. (Mar 2012)
2. Psychological development during adolescence.
a therapist to discuss some aspects of their psycho­ (Mar 2011)
logical functioning. People typically discuss their 3. Developmental stages of an individual. (Mar 2009)
problems with the group, which is often centered 4. Explain the stages of development. (Sept 2009)
around a common difficulty such as alcoholism or
lack of social skills. The other members of the group Short Answers
provide emotional support and describe how they 1. Geriatric Problems. (Mar 2012)
have coped effectively with similar problems. In 2. Psychological needs of infants.
group therapy several people are treated simultane­ 3. Grief.
ously, it is a much more economical means of treat­ 4. Mourning and loss.
ment than individual therapy. Group is effective in 5. Psychological reactions of terminal illness.
 CHAPTER

Mental Hygiene
and Mental Health 7
MENTAL HYGIENE Thus, mental health would include not only the
absence of diagnostic labels such as schizo­phrenia and
Mental hygiene is the science, which studies laws obsessive compulsive disorder, but also the ability to
and means of curing and preventing mental diseases, cope with the stressors of daily living, freedom from
personality disorders and other abnor­malities for anxieties and generally a positive outlook towards
balancing adjustment and healthy development of change in fortunes and to cope with those.
personality.
CONCEPTS OF MENTAL HYGIENE
Definition
Mental hygiene consists of measures to reduce the Prevention
incidence of mental illness through prevention and
early treatment and to promote mental health. The measures to be followed in preventing mental
(Singh and Tiwari—1971) illnesses are:
™™ Identifying the causes leading to mal­adjust­ment,
whether personal or social and taking suitable
MENTAL HEALTH precautions to eliminate the same.
Mental health is a state of balance between the ™™ Suggesting ways and means for achieving
individual and the surrounding world, a state of emotional and social adjustment.
harmony between oneself and others, a coexistence ™™ Suggesting methods for resolving inner conflicts
between the realities of the self and other people and and frustration for getting rid of anxieties, tension
the environment. and emotional disturbances.

Definitions Preservation
An adjustment of human beings to the world and One can enjoy good mental health, if suitable care
to each other with a maximum of effectiveness and is taken for its preservation and promotion. The
happiness.  (Karl Menninger—1947) following activities preserve mental health:
Simultaneous success at working, loving and ™™ Develop the inner potential of an individual.
creating with the capacity for mature and flexible ™™ Attain emotional maturity and stability.
resolution of conflicts between instincts, cons­cience, ™™ Achieve personal and social security and adequacy.
important other people and reality. ™™ Promote healthy human relationships and group
The American Psychiatric Association (APA—1980) interaction.
 Mental Hygiene and Mental Health 159
Curative Measures Integration
An individual can enjoy good mental health to the Integration includes the ability to adaptively respond
extent one is cured as early as possible of mental to the environment and the development of a
illnesses and diseases he is suffering from. The philosophy of life, both of which help the individual
following are some curative measures: maintain anxiety at a manageable level in response to
™™ Adequately equip with the knowledge regar­ding stressful situations.
types of mental illnesses and disorders.
™™ Suggest various therapies for treatment and Autonomy
curing mental illnesses and disorders.
Refers to the individual’s ability to perform, in an
™™ Suggest methods for rehabilitation and readjust-
independent self-directed manner; the individual makes
ment of mentally ill persons.
choices and accepts responsibility for the outcomes.
Balanced Development of the
Perception of Reality
Personality
The balanced develop­ment of personality holds the Perception of reality includes perception of the
key for an individual’s adjustment with one own self environment without distortion, as well as the
and the environment. Lack of balanced development capacity for empathy and social sensitivity—a
in all aspects of personality results in maladjustment respect and concern for the wants and needs of others.
and un­ happiness. Thus, all round personality
develop­ment is a prerequisite for an individual to be Environmental Mastery
emotionally stable and well balanced. Environmental mastery indicator suggests that the
individual has achieved a satisfactory role within the
Leading Happy and Contented Life group, society or environment. He is able to love and
The ability of an individual to lead a fuller and a accept the love of others.
happier life is directly proportional to the mental
health enjoyed by him. Thus, an individual must CHARACTERISTICS OF A MENTALLY
always strive to get along with himself and his HEALTHY PERSON
environment well and avoid unnecessary anxie­ties,
conflicts and frustrations. ™™ He has an ability to make adjustments.
™™ He has a sense of personal worth, feels worthwhile
CONCEPTS OF MENTAL and important.
HEALTH—JAHODA (1958) ™™ He solves his problems largely by his own effort
and makes his own decisions.
A Positive Attitude Towards Self ™™ He has a sense of personal security and feels
secure in a group, shows understanding of other
A positive attitude towards self includes an objective people’s problems and motives.
view of self, including knowledge and acceptance ™™ He has a sense of responsibility.
of strengths and limi­tations. The individual feels a ™™ He can give and accept love.
strong sense of per­sonal identity and security within ™™ He lives in a world of reality rather than fantasy.
the environment. ™™ He shows emotional maturity in his behavior,
and develops a capacity to tolerate frustration
Growth, Development and the Ability and disappointments in his daily life.
for Self-Actualization ™™ He has developed a philosophy of life that gives
Growth, development and the ability for self- meaning and purpose to his daily activities.
actualization indicator correlates with whether the ™™ He has a variety of interests and generally
individual successfully achieves the tasks associated lives a well-balanced life of work, rest and
with each level of development. recreation.
160 Psychology for Nurses

WARNING SIGNS OF POOR PROMOTIVE AND PREVENTIVE MENTAL

MENTAL HEALTH HEALTH STRATEGIES
Symptoms of mental disorders vary depending on In the 1960s, psychiatrist Gerald Caplan described
the type and severity of the condition. Some general levels of prevention specific to psychiatry.
symptoms that may suggest a mental disorder He described primary prevention as an effort
include: directed towards reducing the incidence of mental
disorders in a community. Secondary prevention
In Younger Children refers to decreasing the duration of disorder, while
™™ Changes in school performance tertiary prevention refers to reducing the level of
™™ Poor grades despite strong efforts impairment.
™™ Excessive worrying or anxiety
™™ Hyperactivity Primary Prevention
™™ Persistent nightmares Primary prevention seeks to prevent the occurrence
™™ Persistent disobedience and/or aggressive behavior of mental disorders by strengthening individual,
™™ Frequent temper tantrums family and group coping abilities.

In Older Children and Adolescents Role of a Nurse in Primary Prevention

™™ Abuse of drugs and/or alcohol Community mental health nurses are in a key
™™ Inability to cope with daily problems and position to identify individual, family and group
activities needs, conflicts and stressors. Thus, they play a
™™ Changes in sleeping and/or eating habits major role in identifying high-risk groups and
™™ Excessive complaints of physical problems preventing the occurrence of mental illness in them.
™™ Defying authority, skipping school, stealing or Some interventions include:
damaging property
™™ Intense fear of gaining weight Individual Centered Intervention
™™ Long-lasting negative mood, often along with ™™ Antenatal care to the mother and edu­cating her
poor appetite and thoughts of death regarding the adverse effects of irradiation,
™™ Frequent outbursts of anger certain drugs and prematurity.
™™ Ensuring timely and efficient obstetrical
In Adults assistance to guard against the ill effects of
™™ Confused thinking anoxia and injury to the newborn at birth.
™™ Long-lasting sadness or irritability ™™ Dietary corrections to those infants suffering
™™ Extreme highs and lows in mood from metabolic disorders.
™™ Excessive fear, worrying or anxiety ™™ Correction of endocrine disorders.
™™ Social withdrawal ™™ Liberalization of laws regarding termination of
™™ Dramatic changes in eating or sleeping habits pregnancy, when it is unwanted.
™™ Strong feelings of anger ™™ Training programs for physically and mentally
™™ Delusions or hallucinations (seeing or hearing handicapped children like blind, deaf, mute and
things that are not really there) mentally subnormal, etc.
™™ Increasing inability to cope with daily pro­blems ™™ Counseling the parents of physically and
and activities mentally handicapped children, with particular
™™ Thoughts of suicide reference to the nature of defects. The parents
™™ Denial of obvious problems need to accept and emotionally support the child
™™ Many unexplained physical problems and be satisfied with limited goals in the field of
™™ Abuse of drugs and/or alcohol achievement.
 Mental Hygiene and Mental Health 161
™™ Fostering bonding behaviors. Explaining impor- ™™ Providing marital counseling for those having
tance of warm, accepting, intimate relationship marital problems.
and avoiding the prolonged separation of mother
and child are essential. Interventions for Families in Crisis
In developmental crisis, situations such as the child
Interventions Oriented to the Child passing through adolescence, birth of a new baby,
in the School retirement or menopause, death of a wage earner
™™ Teaching growth and development to parents and in the family, desertion by the spouse, etc. crisis
teachers. intervention can be given at:
™™ Identifying the problems of scholastic perfor- ™™ Mental hygiene clinics
mance and emotional disturbances among school ™™ Psychiatric first-aid centers
children and giving timely intervention. School ™™ Walk-in clinics
teachers can be taught to recognize the beginning
symp­toms of problems and referring to appropri- Mental Health Education
ate agencies. ™™ Conduct mass health education programs
through film shows, flash cards and appropriate
Family Centered Interventions to Ensure audio-visual aids, regarding prevention of mental
Harmo­nious Relationship illnesses and pro­motion of mental health in the
™™ Consulting with parents about appro­priate disci- community.
™™ Educate health workers regarding preven­
plinary measures.
™™ Promoting open health communication in families. tion of mental illness, so that they can function
™™ Rendering crisis counseling to the parents of effectively in all the areas of prevention.
physically and mentally handicapped children.
™™ Ensuring harmonious relationship among mem- Society-centered Preventive Measures
bers of the family and teaching healthy adaptive ™™ Community development.
techniques at the time of stress producing events. ™™ Culturally deprived families need biolo­gical and
psychosocial supplies. They need better hygienic
Interventions Oriented to Keep Families Intact living conditions, proper food, education, health
facilities and recreational facilities. Otherwise
™™ Extending mental health education services psychopathy, alcoholism, drug addiction, crime
at child guidance clinics about child rearing and mental illness, will result in such situations.
practices; at parent-teacher associations regard- ™™ Collection and evaluation of epidemiolo­ gical,
ing the triad relationship between teacher, child biostatistical data.
and parent and at various extramural health agen-
cies regarding integration of mental health into Secondary Prevention
general health practice.
™™ Strengthening social support for the frustrated Secondary prevention targets people who show early
aged and helping them to retain their usefulness. symptoms of mental health disruption, but regain
™™ Promoting educational services in the field of premorbid level of functioning through aggressive
mental health and mental hygiene. treatment.
™™ Developing parent-teacher associations.
™™ Rendering home-maker services—when there is Role of a Nurse in
absence of the mother from home due to illness Secondary Prevention
or other reasons for prolonged periods, the public ™™ Early diagnosis and case finding: This can be
health nurse can arrange for the service. achieved by educating the public, community
162 Psychology for Nurses

leaders, industrialists, Mahila Mandals, balwadis, monitoring the progress of discharged patients in
etc. in how to recognize early symptoms of halfway homes, houses, etc. especially with regard to
mental illness. Case finding through screening their medication regimen, coordination of care, etc.
and periodic examination of population at risk,
monitoring of patients, etc. Thus, in clinics, Role of a Nurse in Tertiary Prevention
schools, home, health care and the work place,
community mental health nurses detect early ™™ Family members should be involved actively in
signs of increased levels of anxiety, decreased the treatment program, so that effective follow-
ability to cope with stress and failure to perceive up can be ensured.
self, the environment and/or reality accurately ™™ Occupational and recreational activities should
and provide direct services as appropriate. be organized in the hospital, so that idling is
™™ Early reference: The public should be educated prevented.
to refer these cases to proper hospitals as soon as ™™ Community based programs can be launched by
they recognize early symptoms of mental illness. meeting the family members when the need for
™™ Screening programs: Simple questionnaires discharge from the hospital should be emphasized.
should be developed to identify the symptoms of These programs can be implemented through
mental illness and administration of the same in day hospitals, night hospitals, after care clinics,
the community for early identification of cases. half-way homes, ex-patient hostels, foster care
These questionnaires can be simplified in local homes, etc. Follow-up care can be handed over
languages and used widely in colleges, schools, to community health nurses.
industries, etc. ™™ There should be constant communication between
™™ Early and effective treatment for patient, and the community health nurses and the mental
if necessary, to family members as relevant; health institution regarding the follow up of the
providing counseling services to caregivers of discharged patient. The ultimate aim of the hospital
mentally ill patients. and community-based programs is to re-socialize
™™ Training of health personnel: Orientation courses and re-motivate the patient for a functional role in
should be provided to health workers to detect the community, consistent with his resources.
cases in the course of their routine work. ™™ There are a wide range of services that need to
™™ Consultation services: Nurses working in general be provided to patients as part of the tertiary
hospitals may come across various conditions prevention program. Nurses need to be fami­
such as puerperial psychosis, anxiety states, liar with the agencies in the community that
peptic ulcer, ulcerative colitis, bronchial asthma, provide these services. Collaborative relation­
etc. These basic care providers need guidance ships between mental health care providers and
and consultation to deal with such conditions in community agencies are absolutely essential, if
an effective manner. rehabilitation is to succeed.
™™ Crisis intervention: If crisis is not tackled in time, ™™ An important intervention in the maintenance of
it may lead to mental disorders or even suicide. patients at their own homes in the community
Sometimes, anticipating the crisis situation and is the Training in Community Living (TCL)
guiding the individual in time can help them to program, designed by ‘Stein and Test’. In this
cope with the crisis situation in a better way. model, when a person is referred for hospital
admission the staff goes to the community with
Tertiary Prevention him rather than he going to the hospital to be
Tertiary prevention targets those with mental illness with the staff. This real world experience with
and helps to reduce the severity, discomfort and the patient enables the nurse to accurately assess
disability associated with their illness. In these terms, the skills that the person needs to develop and to
community mental health nurses play a vital role in mutually agree on realistic goals.
 Mental Hygiene and Mental Health 163
™™ Another aspect of community life that is more important role in the absence of a formal or well-
difficult to assess accurately and deal with functioning mental health system, filling the gap
effectively, is the stigma attached to mental between community needs and available community
illness. Many patients and their families try services and strategies.
to avoid stigma by keeping the nature of the Voluntary organizations can specially play an
person’s illness a secret. The need for secrecy important role in developing suicide prevention and
places additional stress on the family system, crisis support, formation of self-help of families,
because there is always the fear that the truth will organizing community-based housing facilities
be revealed. Nurses in the community are in a for short-term and long-term care of persons with
key position to monitor community attitudes and chronic illnesses, setting up of day-care centers,
help in fostering a realistic attitude towards the sheltered employment facilities, life skills programs
mentally ill. for school drop-out children and public mental health
™™ For some patients, the emotional climate of the education.
family to which they return can have a significant
effect on their adjustment and eventually Non-Governmental Organizations
recovery from the debilitating effects of chronic Non-governmental organizations (NGOs) are rec-
mental illness. Families sometimes view mental ognized by governments as non-profit or welfare
illness as a weakness of character that can be oriented organizations, which play a key role as
overcome by exertion of moral effort. This advocates, service providers, activists and research-
type of familial attitude may result in guilt on ers on a range of issues pertaining to human and
the part of the patient who believes that he has social development. Mental health non-governmen-
disappointed his significant others. Guilt leads tal organizations (MHNGOs) are located throughout
to increased anxiety and decreased self-esteem. India. While many are formed in urban areas, they
These are the conditions that interfere with a high have begun to extend services in rural areas too.
level of functioning. Therefore, nurses working
with families need to foster healthy attitudes Partial Hospitalization
towards the mentally ill member.
Partial hospitalization is an innovative alternative
to hospitalization. It is ideally suited to most of the
MENTAL HEALTH SERVICES psychiatric syndromes, particularly chronic psychotic
disorders, neurotic conditions, personality disorders,
Mental Health Agencies—Government drug and alcohol dependence and mental retardation.
at National Level Day-care centers, day hospitals and day treatment
There are 42 mental hospitals in the country with a programs come under partial hospitalization. Partial
bed availability of 20,893 in the Government sector. hospitalization has the advantages of lesser separation
In the private sector, there are 5,096 beds. These from families, more involvement in the treatment
facilities have to manage an estimated 1.02 crore program and a lessening of patient’s preoccupation
people with severe mental illness and 5.12 crore with the illness, which may be intensified by full
people with common mental disorders. hospitalization.

Mental Health Agencies—Voluntary Quarterway Homes

Voluntary organizations are a valuable community Quarterway home is a place usually located within
resource for mental health. They are often more the hospital campus itself, but not having the regular
sensitive to the local realities than centrally driven services of a hospital. There may not be routine nursing
programs and are usually strongly committed to staff or routine rounds and most of the activities of the
innovation and change. They often play an extremely place are taken care of by the patients themselves.
164 Psychology for Nurses

Halfway Home Other Mental Health Services

A halfway home is a transitory residential center ™™ Community group homes
for mentally ill patients who no longer need the ™™ Large homes for long-term care
full services of a hospital, but are not yet ready ™™ Hostels
for a completely independent living. It attempts to ™™ Home care programs
maintain a climate of health rather than of illness ™™ District rehabilitation centers
and to develop and strengthen individual capa­
cities. At the same time, it enables the recognition of EGO DEFENCE MECHANISMS
problems that require medical attention and permits AND IMPLICATIONS
the discovery of conditions in the community, which
are acting adversely on the individual. Thus, halfway Motives cause conflicts and in turn conflicts cause
homes have a major role in the rehabilitation of the anxiety, stress and frustration in the individual. In our
mentally ill individual. life, we want many things and have different goals.
But we cannot achieve everything we aspire for. In
Self-help Groups many instances, we become frustrated when we fail
™™ Self-help groups are composed of people who in our attempts. These failures and frustrations hurt
are trying to cope with a specific problem or life our ego and cause a lot of anxiety and feelings of
crisis and have improved the emotional health and guilt. Under such circumstances, we do not want to
well-being of many people. Usually, organized accept failure easily. Instead, we resort to certain
with a particular task in mind, such groups do not mechanisms by which we can safeguard our self-
attempt to explore individual psychodynamics respect. The mechanisms used for maintaining
in great depth or change personality functioning harmony with environment can be grouped into two
significantly. categories: direct and indirect methods.
™™ A distinguishing characteristic of self-help
groups is their homogeneity. The members have Direct Methods
same disorders and share their experiences good Direct methods are employed by the individual
or bad, successful or unsuccessful, with one intentionally at the conscious level. These include:
another. The members work together using their ™™ Increasing trials or improving efforts: When
strengths to gain control over their lives. By one finds it difficult to solve a problem or
doing so, they educate each other, provide mutual
faces obstacles in the path, to cope with his
support and alleviate the sense of alienation,
environment, he can attempt with a new zeal
usually felt by people drawn to this kind of a
by increasing his efforts and improving his
group. In other words, self-help groups are based
behavioral process.
on the premise that people who have experienced
™™ Adopting compromising means: For maintaining
a particular problem are able to help others who
have the same problem. harmony between his self and the environment
one may adopt the following compromising
Suicide Prevention Centers postures:
−− He may altogether change his direction of
There are many suicide prevention centers in India
in the voluntary sector doing good work and helping efforts by changing the original goals, i.e. an
those in need. Some of them are: aspirant for Indian Administrative Service
™™ Helping Hands and Medico-Pastoral Association (IAS) may direct his energies to become an
(MPA) in Bangalore officer in a nationalized bank.
™™ Sneha in Chennai −− He may seek partial substitution of goal like
™™ Sahara in Mumbai selection for the provincial civil services in
™™ Sanjivini and Sumaitri in New Delhi place of IAS.
 Mental Hygiene and Mental Health 165
™™ Withdrawal and submissiveness: One may learn tionally painful thoughts, feelings or events. Ego
to cope with one’s environment by just accepting defence mechanisms though originally conceived by
defeat and surrendering oneself to the powerful Sigmund Freud, much of the development of defence
forces of environment and circumstances. mechanisms was done by his daughter Anna Freud.
Ego defence mechanisms also referred to as defence
Indirect Methods mechanisms, are considered as protective barriers
Indirect methods are those methods by which a person to manage instinct and affect in stressful situations
tries to seek temporary adjustment to protect him for the (Freud, 1946).
time being against a psychological danger. These are
purely psychic or mental devices—ways of perceiving Purposes
situations as he wants to see them and imagining that
things would happen according to his wishes. The purpose of Defence mechanisms is to reduce
The ego usually copes with anxiety through or eliminate anxiety. They may be used to resolve a
rational means. When anxiety is too painful, the mental conflict, to reduce anxiety or fear, to protect
individual copes by using defence mechanisms one’s self-esteem or to protect one’s sense of security.
to protect the ego and diminish anxiety. Such Depending upon their use, they are therapeutic or
mechanisms are also called mental mechanisms or pathological.
ego defence mechanisms. They can be helpful when used in very small
doses and if overused, become ineffective and can
Ego Defence Mechanisms lead to a breakdown of the personality. Most defence
Ego defence mechanisms are methods of attempting mechanisms operate at the unconscious level of
to protect self and cope with basic drives or emo- awareness (Table 7.1).

Table 7.1: Commonly used defence mechanisms

Defence mechanism and description Example Overuse can lead to

Repression: Unconscious and Forgetting a loved one’s birth day after Conscious perception of in-
involuntary forgetting of painful ideas, a fight stincts and feelings is blocked
events and conflicts in repression
Denial: Unconscious refusal to admit The mother of a child who is fatally Repression, dissociative
an unacceptable idea or behavior ill may refuse to admit that there is disorders
anything wrong, even though she is
fully informed of the diagnosis and
expected outcome. It is because
she cannot tolerate the pain that
acknowledging reality would produce
Displacement: Unconsciously A husband comes home after a bad Loss of friends and
discharging pent-up feelings to a less day at work and yells at his wife relationships, confusion in
threatening object communication
Reaction formation: Replacing A jealous boy who hates his elder Failure to resolve internal
unacceptable feelings with their brother may show him exaggerated re- conflict
exact opposites spect and affection towards him
Rationalization: It is a process A student who fails in the examination Self-deception
in which an individual justifies his may complain that the hostel atmo-
failures and socially unacceptable sphere is not favorable and has result-
behavior by giving socially approved ed in his failure
reasons

Contd...
166 Psychology for Nurses

Contd...
Sublimation: Consciously or Aggressiveness might be transformed Sublimation allows instincts
unconsciously channeling instinctual into competitiveness in business or to be channeled, rather than
drives into acceptable activities sports blocked or diverted
Compensation: Consciously A student who fails in his studies may Modest instinctual satisfaction
covering up for a weakness by compensate by becoming the college occurs
over emphasizing or making up a champion in athletics
desirable trait
Projection: Unconsciously (or A person who blames another for his Fails to learn to take personal
consciously) blaming someone else own mistakes is using the projection responsibility. May develop
for one’s difficulties mechanism. A surgeon whose patient into delusional tendencies
does not respond as he anticipated,
may tend to blame the theater nurse
who helped that surgeon at the time of
operation
Intellectualization: Undue emphasis Person shows no emotional Excessively using intellectual
is focused on the inanimate in order expression when discussing a serious processes to avoid affective
to avoid intimacy with people, atten- car accident expression on experience
tion is paid to external reality to avoid
the expression of inner feelings and
stress is excessively placed on irrel-
evant details to avoid perceiving the
whole
Undoing: Trying to reverse or ‘undo’ You have feelings of dislike for May send double message
a thought or feeling by performing an someone, so you buy them a gift
action that signifies an opposite feel-
ing than original thought or feeling
Regression: Reverting to an older, An adult throws a temper tantrum when May interfere with progression
less mature way of handling stresses he does not get his own way and development of personality
and feelings
Dissociation: The unconscious Amnesia that prevents recalls of previ- One of the dissociative
separation of painful feelings and ous days auto accident. disorders
emotions from an unacceptable idea, Adult remembers nothing of childhood
situation or object sexual abuse
Conversion: The unconscious A student awakens with a migraine Anxiety not dealt with can
expression of intrapsychic conflict headache the morning of a final exami- lead to actual physical
symbolically through physical nation and feels too ill to take the test disorders such as gastric
symptoms ulcers
Suppression: Voluntary rejection of Student who failed in an examination, Discomfort is acknowledged,
unacceptable thoughts or feelings states he is not ready to talk about his but minimized
from conscious awareness marks
Substitution: Unconscious A student nurse decides to work in Discomfort is acknowledged,
replacement of unacceptable teaching side, because she is unable but minimized
impulses, attitudes, needs or to master clinical competencies
emotions with those that are more
acceptable
Isolation: Attempting to avoid Acting aloof and indifferent towards Avoids dealing with true
a painful thought or feeling by someone when you really dislike that feelings that increases stress
objectifying and emotionally person
detaching oneself from the feeling
 Mental Hygiene and Mental Health 167
Types of Defence Mechanisms Relevance to Nursing Practice
Defence mechanisms can be divided into adaptive The nurse must recognize and understand mala-
and maladaptive mechanisms (Table 7.2). daptive defence mechanisms that patients use. The
nurse has to carefully point out these mechanisms
Implications and work with patients to encourage adaptive be-
™™ Defence mechanisms enable a person to resolve haviors and discourage maladaptive ones.
conflicts. They are essential to the maintenance
of normal equilibrium. PERSONAL AND SOCIAL ADJUSTMENT
™™ Difficulties only occur if the defence mechanisms
Many individuals have a desire to attain great
are inadequate to deal with anxiety or inappropriate
wealth or to become extremely popular or famous,
to the situation in which they are used.
but hardly a few of them attain these. Those of
™™ Many mental mechanisms are a means of
them, who take their failures realistically, become
compromising with forbidden desires, feeling of
satisfied with what they have attained and face the
guilt, etc.
world squarely. They can be called well-adjusted
™™ When mental mechanisms are used moderately
individuals. But those who are always brooding over
they are harmless and help to face conflicts and
their failures or adopt abnormal means to satisfy
frustrations easily and protect ego and also help
their desire for power or wealth by becoming too
to relieve tensions and feel comfortable.
arrogant or day dreamers, etc. are the persons who
™™ Excessive and persistent use of these defence
have a maladjusted personality.
mechanisms is harmful. They do not solve the
problems, but only relieve the related anxiety.
Too much dependence makes us unable to face
Definitions
problems. For example, if a student is unable Adjustment means the modification to compen­sate
to face the examination and withdraws from for or meet special conditions. (Webster—1951)
taking it, he may experience greater difficulty in Adjustment is the interaction between a person
the next attempt. Hence, it is better to learn to and his environment. How one adjusts in a particular
face the problems instead of resorting to these situation depends upon one’s personal characteristics
mechanisms. as also the circumstances of the situation. In other
™™ Many times more than one mechanism may words, both personal and environmental factors work
operate in the process of adjusting to the side by side in adjustment. An individual is adjusted,
situation. if he is adjusted to himself and to his environment.
 (Arkoff—1968)
Table 7.2: Types of defence mechanisms
Adaptive defence Maladaptive defence Areas of Adjustment
mechanisms mechanisms Adjustment, although seeming to be a universal
Repression Displacement characteristic like quality, it may have different
Rationalization Denial aspects and dimensions, such as:
Intellectualization Isolation ™™ Health adjustment
Compensation Suppression ™™ Emotional adjustment
Sublimation Regression ™™ Social adjustment
Substitution Reaction formation ™™ Home adjustment
Projection ™™ School or professional adjustment
Conversion Adjustment of a person is based on the harmony
Dissociation
between his personal characteristics and the demands
Undoing
of the environment of which he is a part. Personal and
168 Psychology for Nurses

environmental factors work side by side in bringing in our life, because they contribute to the process
about this harmony. of adjustment. The way we interact with people
depends to a great extent upon how we perceive them
Personal Adjustment and how we interpret their behavior. The perceptions
Personal adjustment is a process of harmony between about people—what we think, what they are like—
the individual and his environment. The individual influence the way we respond to them. If you
purposefully applies efforts and energy not only perceive that a student is hostile, you are unlikely to
to accommodate perfectly within the society and interact or adjust with him/her. Your behavior in a
the environment, but also to fulfill his needs and group is certainly different from the behavior when
lead a happy social life. The adjustment is highly alone. Group affects an individual’s behavior. The
selective and a specialized process. The adjustment mere presence of others affects our performance.
of an individual is more dynamic and capable of Our social perceptions of others are initially based
readjustment with new environment and there is on the information we obtain about them and in some
remarkable mobility in the process of adjustment. instances on the attribution (inferences) we make
about the causes for their behavior. It is, of course,
Characteristics of a Well-adjusted Person important to have an accurate knowledge of others
before deciding on the kind of possible interactions
™™ Basic needs are satisfied
with them. Our perceptions of other’s personalities
™™ Leads balanced life
and feelings guide us in deciding the way we respond
™™ Respects self and others
to them and what sort of relationships we have
™™ Has realistic goals
with them. Knowledge about others influences our
™™ Aware of one’s own strengths and weaknesses
adjustment with them.
™™ Flexible mind-set
™™ Ability to deal with adverse circumstances
™™ Realistic perception of the world GUIDANCE AND COUNSELING
™™ Comfortable with the surrounding environ­ment One of the most important areas in education,
™™ Absence of fault-finding attitude which has acquired considerable importance and
received much attention in recent years is guidance
Social Adjustment and counseling. Present day nurses have to acquire
As social beings we live in a society. We form some specialized knowledge regarding guidance and
opinions about others and others form opinions about counseling in order to guide the patients tactfully in
us. Everybody wants acceptance and recognition this highly compe­titive world.
from and within the society. We try to behave
according to the norms of the society, so that we can Definition
adjust with others. Guidance is the assistance made available by qualified
Social adjustment can be defined as a psycholog- and trained person to an individual of any age, to
ical process. It frequently involves coping with new help him to manage his own life activities, develop
standards and values in the society. In the technical his own point of view, make his own decision and
language of psychology, getting along with the mem- carry on his own burden. (Crow and Crow—1951)
bers of the society as best as one can is called social In educational context, guidance means assisting
adjustment. students to select courses of study appropriate to their
needs and interests, achieve academic excellence to
Perception and Social Adjustment the best possible extent, derive maximum benefit of
Impartial perception is needed for social adjustment. the institutional resources and facilities, inculcate
The processes of behavior, e.g. learning, maturation, proper study habits and satisfactorily participate in
sensation, perception and motivation are significant curricular and extracurricular activities.
 Mental Hygiene and Mental Health 169
Principles of Guidance Areas of Guidance
Basic aim of guidance is to help the individual to Every individual, at sometime or other needs help to
attain his full personal, social, professional, cultural become happier, more creative and better adjusted in
and spiritual development. According to Crow and his family and society. There are several areas, where
Crow (1951), there are 14 principles in guidance. a student requires assistance. These areas can be
 Every aspect of an individual’s complex classified into education, vocation, personal, social,
personality patterns constitutes a significant avocation, health, moral, religion and financial.
factor of his total display of attitude and
behaviors. Educational Guidance
 Although all human beings are similar in many Educational guidance helps the students to get
ways, individual differences must be recognized. maximum benefit out of education and solve their
 The function of guidance is to help a person: problems related to education. The emphasis is
a. Formulate and accept stimulating worthwhile, on providing assistance to students to perform
and attainable goals of behavior. satisfactorily in their academic work, choose the
b. Apply these objectives in conducting his appropriate course of study, overcome learning
affairs. difficulties, foster creativity, improve levels of
 Existing social, economic and political unrest motivation, utilize institutional resources optimally
is giving rise to many maladjustive factors that such as library, labo­ratory, etc.
require the cooperation of experienced guidance
workers. Vocational Guidance
 Guidance is a continuous process. Vocational guidance is the assistance provided for
 Guidance is not limited to a few. selection of a vocation and preparation for the same.
 Guidance is education, but not all education is It is concerned with enabling students to acquire
guidance. information about career opportunities, career
 Generally accepted areas of guidance include growth and training facilities.
concern with the extent to which an individual’s
physical, mental health interference with his Personal Guidance
adjustment to home, school and vocational Personal guidance refers to the guidance offered to
demands. students enabling them to adjust themselves to their
 Guidance is fundamentally the responsibility of environment, so that they become efficient citizens.
parents in the home and teachers in the school. Ado­lescent behavior to a great extent depends upon
 Specific guidance problems in any age level the moods and attitudes of the adolescent. Emotional
should be referred to persons trained to deal with instability is a characteristic of adolescents and
particular areas of adjustments. this is often the cause of many of their personal
⓫ Programs of individual evaluation and problems. Personal guidance will help them to solve
research should be conducted, and progress these problems. Severe competition and irrational
and achievement made accessible to guidance expectations of the parents also lead to personal
workers. problems. Students may find it difficult to follow the
⓬ The guidance program should be flexible in lectures, especially when exposed to a new medium
terms of individual and community needs or else of instruction. Difficulty in under­standing in turn
it will lose its value. leads to disliking of teachers and ultimately results
⓭ Continuous or periodic appraisals should be in poor achievement. Guidance needs to be provided
made. to such students to enable them to adjust to the
⓮ Guidance is preventive rather than curative. situation, which they cannot change.
170 Psychology for Nurses

Social Guidance Definition

Social guidance enables the student to make Counseling is an accepting, trusting and safe
substantial contributions to the society, assume relationship in which clients learn to discuss openly
leadership, confirm to the social norms, work what worries and upsets them, to define precise
as team members, develop healthy and positive behavior goals to acquire essential social skills
attitudes, appreciate the problems of society, respect and to develop the courage and self-confidence to
the opinions and sentiments of fellow human beings, implement the desired new beha­viors.
acquire traits of patience, perseverance and friend­  (Merle M Ohlsen—1977)
ship. Its main purpose is to enable the student to
become an efficient citizen. Principles of Counseling
™™ Respect: Counselors ability lies in communi­
Avocational Guidance ca­ting to the client the belief that every person
possesses an inherent strength and capacity, the
Avocational guidance is the assistance to be provided
right to choose his own alternatives and make his
to students to spend their available leisure time
own decisions.
profitably. Activities and programs outside the
™™ Authenticity: Counselor should have genui­
formal classrooms provide many opportunities for
neness, honesty and simplicity and avoid
the blossoming of talents of students.
superiority feeling.
™™ Non-possessive warmth: Demonstration of
Health Guidance
concern, interest and value for others and a deep
Health guidance implies the assistance rendered concern for the well-being of the other person.
to students for main­ taining sound health. Sound ™™ Non-judgmental attitude: Avoid bias making
health is a prerequisite for participating in curricular assumptions or judgments about the client.
and co-curricular activities. This type of guidance ™™ Accurate understanding of the client: It includes
focuses on enabling students to appreciate conditions precise evaluation of the perceptual and cognitive
for good health and take steps necessary for ensuring behavior of the individual.
good health, main­taining sound physical and mental ™™ Recognizing the client’s potential: Recognizing
health. the strengths and abilities of the client.
™™ Confidentiality: Maintain confidentiality and
Financial Guidance develop trust. Avoid revealing client’s identity,
The function of financial guidance is to help the needy personal details and other information without
students in determining the financial assistance they consent. Assure confidentiality to the client.
need in the light of the expected expenses and to get
it from financial organizations after completing the Who Should be Counseled?
formalities. The following types of students are in urgent need of
counseling:
COUNSELING ™™ Students who have a consistent record of under
achievement.
Counseling is a process of enabling the individual ™™ Students whose scholastic achievement has
to know himself and his present and possible future dropped suddenly.
situations in order that he may make substantial ™™ Students who find it difficult to participate in the
contributions to the society and to solve his own class and extracurricular activities.
problems through a face to face personal relationship ™™ Students who use exhibitionism for gaining
with the counselor. recognition or attention in class.
 Mental Hygiene and Mental Health 171
™™ Students who find it difficult to adjust to the The counselor should take all possible efforts to
college or clinical areas. establish rapport and build a relation­ship of confidence,
™™ Students who suddenly decide to drop out of trust and mutual appreciation. This helps the client to
college. express himself without inhibitions and resistance.
™™ Students who display unusual ability in any
direction—intellectual, artistic, musical, etc. Assessment
™™ Students who have behavioral problems such Assessment phase is concerned with data collection,
as drug addiction, aggressiveness, bullying, analyzing the data and clarification of expec­tations.
stealing, shyness, timidity, etc. The counselee is encouraged to talk about his problems
and ventilate his feelings, whereas the counselor asks
Types of Counseling questions, collects information, observes and possibly
helps the counselee to clearly state his problem.
Individual Counseling Counselee also talks about his expectations.
Individual counseling is a one-to-one helping
relationship between the counselor and the counseled. Diagnosis
It is focused upon the individual’s need for growth and In diagnosis phase, the counselor diagnoses the problem
adjustment, problem solving and decision making. of the individual and decides the areas of intervention.
This type of counseling requires counselors with
the highest level of training and professional skills. Setting Goals
In addition, it also requires that they have a certain In setting goals phase, the counselor explains to the
personality type as well; counseling will be rendered indi­vidual what is possible, i.e. setting goals, which
ineffective, unless counselors exhibit such personality will in turn provide direction to the coun­selee and
traits as understanding, warmth, humanness and counselor. Goals may be of two types—immediate or
positive attitude towards the client. short-term goals and long-term goals. Short-term goals
ultimately lead to the attainment of long-term goals.
Group Counseling
Group counseling form of counseling is sometimes Intervention
successful with clients who have not responded well Interventions are needed to achieve the goals. In
to individual counseling. This group interaction this phase, counselor explains to the individual,
helps the individual to gain insight into his problems how the goals can be achieved. The interventions
by listening to others discussing their difficulties. employed will depend upon the technique used
Group counseling often not only helps the individual by the counselor. The main aspect in this phase
to change, but also enhances his desire and ability to includes developing insight and putting it to work.
help others faced with distressing life circumstances. The process of clarifying and gaining insight leads to
decision making and planning of courses of action.
Phases of Counseling However, the individual alone is res­ponsible for the
 Appointment and establishing relationship decisions he makes, though the counselor may assist
 Assessment in this process by his warmth and understanding.
 Diagnosis
 Setting goals Termination and Follow-up
 Intervention Successful termination is an important aspect in
 Termination and follow-up counseling. It must be done without destroying
the accomplishment gained and should be done in
Appointment and Establishing Relationship a phased manner covering few sessions. This will
Appointment with the counselee is fixed accor­ding to prevent the development of a feeling of sense of
the convenience of both the counselor and counselee. loss in the counselee. Follow-up appointments, i.e.
172 Psychology for Nurses

planning for the next sessions if needed should also Directive or Counselor Centered Counseling
be carried out. The relationship should be planned and The counselor is active and directs the individual in
the client should be well-prepared for termination. making decisions and finding solutions to problems.
Abrupt breaking of contact should be avoided, as it The counselor does not force the individual, but directs
may have an undesirable influence on the client. the process of thinking of counselee by informing,
explaining, interpreting and advising. However, the
Attributes and Skills Required decision has to be taken by the counselee.
for a Counselor
Non-directive or Client-Centered Counseling
™™ Pretraining attributes: A person who has
awareness of her needs, feelings, personal In non-directive counseling, counselee is guided to
strengths and weaknesses, acts as a good use his own inner resources to solve the problem. In
counselor this approach, the counselee plays a predominant role.
™™ Good psychological health
™™ Sensitivity: A person having the ability to Eclectic Counseling
understand an individual acts as a good counselor In eclectic counseling, the strategy arises out of the
™™ Open-mindedness appropriate knowledge of individual behavior and
™™ Objectivity a combination of directive and other app­roaches.
™™ Trustworthiness: The counselor should be Irrespective of the differences, all approaches should
reliable, honest and not hurt others have developmental, pre­ventive and remedial values.
™™ Approachability: Counselor should be friendly,
have positive attitude about others and approach- Areas of Counseling
able without a feeling of appre­hension Counseling About Risks
Counseling about risks involves:
Guidelines for Successful Counseling ™™ Giving information about a problem.
™™ A very careful scheduling of the counseling ™™ Providing opportunity to reflect on the impact of
sessions should be done. Make appointments; the problem on daily life.
this saves time. ™™ Helping to work out ways of reducing this
™™ Provide privacy and maintain confidentiality. impact, or of coming to terms with it.
™™ Know the client before he comes for the session. Examples include counseling about genetic
Gather data from different sources. This can risk, abuse of alcohol or drugs and about acquired
serve as a framework within which the per­son’s immunodeficiency syndrome (AIDS).
problem can be worked upon.
™™ Know your own personality; this prevents Counseling to Relieve Distress
your opinions or attitudes from affecting the Counseling to relieve distress is undertaken for
objectivity of your perception of the client’s clients who are reacting to diffi­cult circumstances.
problems. Examples include coun­seling students, individuals
™™ Be a good listener. with acute reactions to stress (such as anxiety,
depression, insomnia, etc.) and postnatal depression.
Techniques/Approaches to Counseling
Based on the nature of the counseling process and Interpersonal Counseling
the role of the counselor, there are three approa­ches Interpersonal counseling is focused on change in life
to counseling namely directive, non-directive and events, sources of persistent distress in the family or
eclectic counseling. place of work and current difficulties in relationships.
 Mental Hygiene and Mental Health 173
Marriage Guidance Counseling on to be active in all steps of the crisis intervention
Marriage guidance counseling is directed towards process, including clarifying the problem, verbalizing
helping couples to talk constructively about prob- feelings, identifying goals and options for reaching
lems in their relation­ship, understand each others goals and deciding on a plan.
point of view and to identify positive aspects of the
relationship, as well as those causing conflict. Purposes of Guidance and Counseling
™™ Aiding the individual in the identification of his
Problem-solving Counseling abilities, aptitudes, interests and attitudes.
In problem-solving counseling, the client is helped to ™™ Assisting the individual to understand, accept
do the following: and utilize these traits.
™™ List problems that are causing distress. ™™ Helping the individuals to recognize his aspira-
™™ Consider courses of action to solve each problem. tions in the light of his traits.
™™ Select one problem and try out the course of ™™ Providing the individual with opportunities for
action that appears most practical. learning areas of occupation and edu­ cational
™™ Review the results. endeavors.
™™ Choose another problem for solution, if the first ™™ Aiding the individual in the development of value
action has succeeded. senses.
™™ Choose another course of action, if the first has ™™ Helping the individual in developing his
not succeeded. potentials to their optimum, so that he may
These steps are carried out in the context of a become the individual he is capable of beco­ming.
caring relationship. ™™ Assisting the individual in obtaining expe­rience,
which will assist him in the making of free and
Bereavement Counseling wise choices.
Bereavement counseling focuses on working through ™™ Aiding the individual in becoming more and
the stages of grief (i.e. denial, followed by extreme more self-directive.
sadness and finally coming to terms with the loss). It
provides an opportunity for emotional release, and Guidance and Counseling in
advice about the practical problems of living without the Hospital
the deceased person. The problems created due to illness vary not only
with each individual patient, but also with the
Crisis Intervention different stages of the illness and at different points
Crisis intervention approach originated from the of the patient’s hospital experience. When dealing
work of Lindemann (1944) and Caplan (1961). It is with sick people, counselor must keep in mind that
a form of counseling designed to help individuals to they are particularly susceptible to strains, stress
adapt to the immediate effects of severe life events, and conflicts and are often comp­laining, demanding
while acquiring better ways of dealing with future and fault finding. They may misinterpret what is
stressful circumstances. This approach is used to conveyed to him.
treat emotional reactions or disturbed behavior
arising in response to crisis situations such as Problems Faced by Sick People
marriage breakdown, rape, unexpected bereave­ ™™ Fear, anxiety and frustration: Hospitalization
ment and natural disasters such as floods, etc. In brings out fear, anxiety, etc. in the patient.
crisis intervention, the most important aim is that the Uncertainty regarding the diagnosis, its
client should recognize that he has learnt a general implication, strain and tension in facing the
method of dealing with stressful conditions, which unknown future gives rise to feeling of help­
can be used for solving future problems. Treatment lessness, bewilderment and insecurity. Coun­
is usually short, but intensive. The client is called seling helps in reinforcing his feelings of warmth
174 Psychology for Nurses

and importance, which could help to counteract setting involves using all the skills one has, to make
existing anxiety. This can be done through the patient feel at ease and to help him to be healed as
providing reliable and authoritative answers much as cured. Coun­seling is part of the nurse’s duty
to the questions. Help the patient to accept as she carries out total patient care.
the reality of the situation himself, so that he
neither exaggerates the seriousness of illness nor Guidance and Counseling in Nursing
minimizes its impact on the adjustments he will Education
be compelled to make.
™™ Reaction to illness: Feeling of insecurity and Guidance and counseling will assist nurses in
helplessness are common reactions to illness. developing proper attitude, commitment, dedi­cation
Counseling helps in restoring the patient’s sense and other qualities required for a successful nursing
of self-responsibility and encourages the patient practice. Moreover, emerging and re-emerging
to follow prescribed regimen. diseases, technological advancements in patient care
™™ Counseling of families: The counseling cannot be evolving of new specialties, espe­cially in the clinical
confined to the patient, but must be extended to areas, changing role of nurses in health care sector,
family members as well. Social, economic and impact of consumer protec­tion act, etc. underlines
emotional problems, which illness creates for the the need of a viable gui­dance and counseling service
patient have repercussion on the family members in all nursing institutes. The need for guidance and
as well. Positive values inherent in family counseling in nursing education can be summarized
living have to be utilized for the members to get as follows:
adjusted regardless of the degree of incapacity. ™™ To help students adjust with new environment in
Help the family members to gear their demands the nursing institute.
in accordance with the limitations imposed by ™™ To help in developing qualities required for a
illness and assist them in utilizing whatever successful nursing practice.
potentialities the patient possesses for active ™™ To help students in getting adjusted with the
participation in family living. clinical environment.
™™ Problems at discharge: During discharge, if ™™ To help students keep in touch with the latest trends
the patient carries incapacitating residue of the in nursing and to reap benefits from the trends.
illness, it is likely to interfere either temporarily ™™ To help students in developing positive learning
or even permanently with normal functioning. habits, especially in skill learning, so that they
Encouraging the patient in planning for his can retain and transfer the learned lessons in a
return to normal living is a helpful device in better way.
preparing him to assume a greater degree of self- ™™ To help in the development of appropriate
direction. Such help is given by the counselor by coping strategies in order to deal with stress in a
assisting with living arrangements, adjustment productive manner.
or the securing of medical follow-up, which is ™™ To help nursing students in establishing a proper
of value not only because these are concrete identity.
services, essential for the patients well-being, but ™™ To help them develop a positive attitude towards
also a means of enhancing the patients feeling of life.
importance with the visible proof of interest in ™™ To help them overcome periods of turmoil and
his welfare, the patient begins to see himself as a confusion.
person of worth. ™™ To help students in developing their leader­ship
The nurse as a caretaker has a very important role qualities.
in giving all the psychological support to the patient ™™ To motivate them for taking membership in
to solve the problems, cope up with future problems professional organizations after completing their
and overcome them. Counseling work in the nursing studies.
 Mental Hygiene and Mental Health 175
™™ To help them take advantage of the techno­logical 3. Discuss the role of a nurse in the promotion of
advancements in patient care. mental health. (Mar 2011)
™™ To help them develop readiness for change and
4. Explain the different measures that can be taken in
the prevention of emotional and mental disturbances.
face challenges both in personal, as well as
(Apr 2006, 2004)
professional life.
™™ To help them carry out the responsibilities as a
Short Essays
worthwhile health team member.
™™ To help them in proper selection of careers both 1. Guidance and counseling. (Mar 2012)
in India and abroad. 2. Strategies of promotive and preventive mental
health. (Mar 2012)
™™ Motivate them to pursue higher education
3. Briefly explain the preventive strategies in mental
according to their abilities and interest. health. (Sept 2011)
™™ To assist the needy students in availing financial 4. Characteristics of a mentally healthy person. (Mar
assistance from appropriate organi­zations. 2011, Mar 2009)
Knowledge of guidance and counseling are 5. Concepts of mental hygiene and mental health.
necessary for a nurse to become a good non- (Mar 2009)
professional counselor. She also should have a better 6. Explain the steps in the prevention of mental and
emotional disturbances. (Sep 2004)
personality, which will determine her success in 7. Role of nurse in preventing mental distur­bances.
counseling. (Nov 2003)
8. Community organization for care and rehabi­litation
REVIEW QUESTIONS for mentally retarded. (Nov 2003)

Long Essays Short Answers

1. Define defence mechanisms. Explain any two with 1. Rationalization. (Mar 2012)
examples. (Mar 2012, Sept 2011) 2. Ego defence mechanism. (Mar 2012, Mar 2009)
2. Define mental health. Discuss the characteristics of 3. Adjustment. (Mar 2011)
4. Mental health. (Aug 2010)
a mentally healthy person. (Mar 2012)
5. Sublimation. (Sept 2009)
 CHAPTER

8
Psychological
Assessment
and Tests

Psychology has a long tradition of scientific research  Computer-assisted tests: It is a means of ad-
on human behavior and personality. Through this ministering psychological tests to large groups
research, a multitude of psycho­logical assessment of applicants in which an appli­cant’s response
scales have been developed to objectively and determines the level of difficulty of succeeding
precisely measure various aspects of psychological items. For example, in computer-assisted testing
functioning and personality characteristics. individual does not have to waste time answer-
Psychological assessment refers to the types of ing questions below his level of ability. The com-
tests that we use to help identify strengths and areas puter program begins with a question of average
for growth that affect one’s emotional, personal and difficulty and if the individual answers correctly,
professional development or adjustment. Technical it proceeds to questions of greater difficulty. If
term for psychological testing is psychometrics. not it asks less difficult questions.
Psychological tests are standard measures  Paper-pencil and performance tests: These tests
devised to assess behavior objectively and used by are in printed form; answers are recorded on a
psychologists to help people make decisions about standard answer sheet. Performance tests assess
their lives and understand more about themselves. complex skills, such as word processing or
mechanical ability for which paper-pencil tests
TYPES OF PSYCHOLOGICAL TESTS are not appro­priate.
Psychologists categorize tests in two ways based on
how they are constructed and administered and based
CLASSIFICATION OF PSYCHOLOGICAL
on skills and abilities they are designed to measure. TESTS
Classification of psychological tests based on Based on tests of knowledge, skills and abilities
construction and administration: psychological tests have been divided into following:
 Individual and group tests: Individual tests are  Achievement tests: Achievement tests are used
designed to be adminis­tered, to one person at a in educational or employment settings and they
time. Group tests are desig­ned to be administered attempt to measure the achieved know­ledge such
to a large number of people at the same time. as mathematics or spelling. For example, term
 Speed and power tests: Speed tests have a fixed ending exams.
time limit at which point everyone taking the  Aptitude tests: These tests measure specific abilities
test, must stop. Power tests have no time limit, such as mechanical or clerical skills. These include
applicants are allowed as much time as needed to measurement of perceptual speed and accuracy,
complete the test. attention to detail, the capacity to visualize and
 Psychological Assessment and Tests 177
manipulate objects in space, principles of mechani-  Tentative selection of the test items: In the
cal operation, ability to operate computers. For ex- second step after the analysis has been made
ample, general aptitude test battery (GATB), differ- the psychologist selects tests already available
ential aptitude test (DAT). or devices tests, which he feels will measure the
 Intelligence tests: These tests attempt to measure processes.
intelligence, i.e. basic ability to understand the  Development of standardized procedures: Psy-
world around. For example, Stanford-Binet chological tests are administered and scored in
Scale, Army Alpha Test, Army General Classi­ the same way for every individual tested in order
fication Test. to obtain consistent results.
 Interest tests: These psychological tests are meant  Administration of the test to a representative
to assess a person’s interests and preferences; group: In this step the psychologist adminis­ters
used primarily for career counseling. For the test to a representative group of subjects to
example, interest inventory. see if they score the way expert judgment or other
 Neuropsychological tests: These tests measure evidence suggests. In this way psychologists are
deficits in cognitive functioning (ability to think, able to determine the effectiveness of the test.
speak, reason, etc.). The deficit in cognitive  Final selection of the test items: In this process
functioning may result from some sort of brain many test items are either discarded or revised, so
damage such as stroke or a brain injury. For that they contribute more directly to the overall
example, Cambridge Neuropsychological Test purpose of the test. This procedure is called item
Automated Battery (CANTAB), Benton Visual analysis. The final selection of items is based on
Retention Test, Wechsler Adult Memory Scale empirical findings.
(WMS).  Evaluation of the final test: Effectiveness of
 Occupational tests: They attempt to match the final test is evaluated in terms of a specified
interests with the interests of persons in known criterion.
careers. For example, McQuaig Occupational
Test. CHARACTERISTICS OF PSYCHOLOGICAL
 Personality tests: They attempt to measure
TESTS
basic personality style. For example, Minnesota
Multiphasic Personality Inventory (MMPI), Carefully developed and researched psycho­logical
Rorschach inkblot test. tests have several characteristics:
 Specific clinical tests: They attempt to measure  Standardization: It refers to the consistency or
specific clinical matters, such as current level of uniformity of the conditions and pro­cedures for
anxiety or depression. For example, Hamilton administering a test. To achieve standardization,
rating scale for depression, Brief psychiatric people must be tested under uniform conditions.
rating scale.  Objectivity: It refers primarily to the scoring of
the test results. The scoring process must be free
DEVELOPMENT OF PSYCHOLOGICAL of subjective judgment or bias on the part of the
scores.
TESTS
 Test norms: To interpret the results of a
Several steps are involved in development of psychological test, a frame of reference or point
psychological tests. These include: of comparison must be established, so that the
 Analysis of the situation: In the first step detailed performance of one person can be compared with
analysis of the psychological processes required the performance of others. This is accomplished
for successful performance of the task in question by means of test norms. The distribution of
is carried out. test scores of a large group of people is similar
178 Psychology for Nurses

in nature to the individual being tested. For  Directions for administrating scores are precisely
example, a science graduate applies for a job stated, so that procedures are standard for
that requires mechanical skills and achieves a different users of the test.
score of 83 on a test of mechanical ability. This  A test manual and other accessory materials
score alone tells us nothing about the level of the are provided as a guide for administration,
applicant’s skill, but if we compare that score scoring, evaluating its technical qualities and for
of 83 with the test norms—the distribution of interpreting and using the results.
scores on the test from a large group of science
graduates—then we can ascribe some meaning USES OF PSYCHOLOGICAL TESTS
to the individual score. If the mean of the test
norms is 80 and the standard deviation is 10, we  It is easier to get information from tests than by
know immediately that an applicant who scores clinical interview.
83 has only an average or moderate amount  The information from tests is more scien­tifically
of mechanical ability. With this comparative consistent than the information from a clinical
information, we can evaluate objectively the interview.
applicant’s chances of succeeding on the job  They assist in diagnosis. For example, Rorschach
relative to the other applicants tested. Inkblot Test.
 Reliability: It refers to the consistency of a  They assist in the formulation of psycho­pathology
person’s scores. For example, a boy takes a and identification of areas of stress and conflict.
cognitive ability test and achieves a mean score For example, Thematic Apperception Test.
of 100 and after one week if we repeat the test  They help to determine the nature of deficits
and he achieves a mean score of 72, we would present. Example: Cognitive neuro­psycho­logical
describe the test as unreliable because it yields assessments.
inconsistent measurements.  They help in assessing severity of psycho­
 Validity: It refers to the test’s accuracy in pathology and response to treatment. For
measuring, what it is supposed to measure. example, Hamilton rating scale for depression,
For example, if a test is a valid measure of brief psychiatric rating scale.
intelligence, people’s scores on that test should  They help in assessing general characteristics of the
be strongly correlated with their grades in school. individual. Example: assessment of intelligence,
assessment of personality. Personality tests help
PRINCIPLES OF PSYCHOLOGICAL us understand an individual’s interpersonal style,
TESTS basic personality traits and emotional functioning.
 Psychological tests should have three components, In addition to clinical measures for things like
i.e. the standard, content and the procedure, that depression, mood disorders or anxiety, these kinds
make it possible for anybody to administer it of tests may also help identify general personality
anywhere, anytime. traits such as introversion vs. extroversion;
 Tests should have norms to compare an individual dominance vs. submissiveness, leadership style,
test score to the score of a known group, who etc. These personality factors relate to a wide
have taken the test. variety of issues in one’s life including school or
 Test items are of high technical quality prepared work performance, marital or family concerns and
by experts, pretested and selected on the basis of overall happiness.
difficulty, discriminating power and relationship  These tests are also used in forensic evalua­tions,
to a clearly defined rigid set of specifications. litigation, family court issues or criminal charges.
 Psychological Assessment and Tests 179
 These tests assess level of functioning or dis- prognosis for social recovery, motivation for person-
ability, help direct treatment and assess treatment ality change, primary assets and weaknesses, recom-
outcome. mendations and summary.

LIMITATIONS OF PSYCHOLOGICAL ROLE OF A NURSE IN PSYCHOLOGICAL

TESTS ASSESSMENT
 No psychological test is ever completely valid ™™ Nurses should become familiar with the many
or reliable, because the human psyche is just too standardized psychological tests that are available
complicated to know anything about it with full to enhance each stage of the nursing process.
confidence. That is why there can be uncertainty ™™ These tests will help in providing care and provide
about a case even after extensive testing. measurable indicators of treatment outcome.
 Many applicants experience considerable test For example, if the nurse is caring for a patient
anxiety. with depression, it would be helpful to use one
 Negative attitudes toward psychological tests of the depression rating scales with the patient,
may also lower applicant’s motivation to perform at the beginning of care/treatment to establish a
well on the tests, which in turn, reduces the baseline profile of the patient’s symptoms and
predictive validity of the tests. help confirm the diagnosis. The nurse might then
 Administration and interpretation of the test is administer the same scale at various times during
done only by qualified psychologists. the course of treatment to measure the patient’s
progress.
™™ A nurse should have knowledge about all the
INTERPRETATION OF PSYCHOLOGICAL
psychological tests, which will enable her to
TESTS clarify the patient’s and relative’s doubts regar­
The integration of test findings into a comprehensive, ding the psychological tests they have to undergo.
meaningful report is probably the most difficult ™™ The nurse should reassure the patient about
aspect of psychological evaluation. Inferences from the safety of the tests and confidentiality of the
various tests must be related to one another in terms observations of the psychologist. Psychological
of clinicians’ confidence in them and of a patient’s tests are another source of data for the nurse to
presumed level of awareness that consciousness is use in planning care for the patient.
being tapped.
Most clinicians follow some general outline in REVIEW QUESTIONS
preparing a psychological report, such as test behav-
ior, intellectual functioning, personality functioning Short Essays
(reality testing ability, impulse control, manifesta- 1. Characteristics and uses of psychological tests.
tion of depression and guilt, manifestations of major (Mar 2012)
dysfunction, major defenses, overt symptoms, in- 2. Types of psychological tests.
terpersonal conflicts, self-concept, affects), inferred 3. Development of psychological tests.
diagnosis, degree of present overt disturbances, 4. Role of nurse in psychological assessment.
 CHAPTER

Individual
Differences 9
Individuals differ from each other. One individual is Psychological Differences
never like another in all respects. Each one has his Psychological make up generates differences among
own peculiarities, which presents him as a separate us in terms of varying intellectual poten­tialities,
individual from the others. interests, attitudes, emotions, social and moral
In psychological terminology, differences development, etc.
between individuals that distinguish or separate
them from one another and make one distinct, unique Types of Psychological Differences
and stand out from the rest are termed as individual
differences.  Mental differences: People differ in intellectual
ability and capacities like reasoning and thinking,
power of imagination, creative expression,
MEANING OF INDIVIDUAL
concentration, etc.
DIFFERENCES  Differences in intelligence level: Intelligence
According to ‘Dictionary of Education’ by Carter B. level differs from individual-to-individual. We
Good—1959: can classify the individuals from supernormal
 Individual differences stand for the variations or (IQ above 120) to idiots (IQ from 0–50) on the
deviations among individuals in regard to a single basis of their intelligence level.
characteristic or a number of charac­teristics.  Differences in attitudes: Individuals are found
 Individual differences stand for those differences, to possess varying attitudes towards different
which in their totality distinguish one individual people, groups, objects and ideas. Their attitudes
from another. may be positive, negative or some­what indifferent
in nature.
TYPES OF INDIVIDUAL DIFFERENCES  Emotional differences: The individuals also
differ in the manner they express their emotions.
Physical or Physiological Differences Some are emotionally stable and mature, while
Physical differences among individuals are related to others are emotionally unstable and immature.
the differences created on account of the differences in  Differences in motor ability: There exists a wide
terms of physical make up of our bodies. Individuals difference in motor abilities such as reacting
differ in height, weight, color of skin, color of eyes time, speed of action, steadiness, rate of muscular
and hair, size of hands, arms, feet, mouth, nose, movement and resistance to fatigue, etc. At every
waistline, structure and functioning of internal age level differences in motor ability are visible.
organs, facial expression and mannerisms of speech, Some people can perform mechanical tasks with
walk, hairstyle and other physical characteristics. ease and comfort, while others even though at
 Individual Differences 181
the same level, ex­perience much difficulty in external bodily organs, but also makes contri­
performing similar tasks. butions indirectly by creating differences in the
 Differences in interests and aptitudes: Variations individuals in relation to sex, intelligence and
occur among individuals in relation to interests. other specific abilities.
Some take interest in meeting people; attending
social functions, etc. while others prefer Environment
solitude and avoid social gatherings. Some ™™ The environment is every thing that affects the
have mechanical aptitude, while the others have individual except his genes. It covers all the
scholastic, musical or artistic aptitudes. outside factors that act on the individual, since
 Differences in social and moral development: he begins life.
Some are found to be adjusted properly in the social ™™ The first environment for a child is the mother’s
situations and lead a happy social life. Others are womb. The fetus gets its nourishment from the
asocial or antisocial. Similarly people are found to blood stream of its mother. The physiological
differ in respect of ethical and moral sense. and psychological states of the mother during
No two individuals are exactly the same. Individual pregnancy, her habits and interests, all influence
differences in personality and tempera­ment can be the development of the fetus.
™™ After birth the child is exposed to numerous
observed from the day the child is born.
environmental factors such as food, water,
climate, physical atmosphere at home, school,
CAUSES OF INDIVIDUAL DIFFERENCES village, parents, members of the family, friends,
Individual differences are also caused by hereditary neighbors, teachers, society, mass media,
and environmental factors. A child comes to this recreation, religious places, etc. These different
world with certain traits, which determine his environmental factors have a desirable impact on
individual capabilities and thus he differs from the physical, social, emotional, intellectual, moral
others on account of heredity. Also each child is born and aesthetic development of the individual.
in a different environment from the other; therefore ™™ The same geographical environment does not
whatever traits he acquires during his lifetime are guarantee the same physiological effects. If
usually different from the others. children of common heredity are reared apart
in different environments, they will differ
considerably from each other.
Heredity Differences between the individuals is normally
™™ People belong to different hereditary endow­ attributable to both heredity and environment,
ments and characteristics. The heredity decides i.e. the hereditary characteristics and traits the
the path of the progress and deve­lopment of an individual has, as well as the physical, social,
individual. psychological stimulation they receive from their
™™ Heredity provides the limits of one’s growth environments. Both hereditary and environmental
and development in various dimensions and factors are said to be the sole determinants of the
aspects of one’s personality and thus varia­tions wide individual differences found in human beings.
in hereditary characteristics cause differences The influence of heredity and environment cannot
between individuals. be clearly demarcated. They interact, so subtly
™™ Heredity not only contributes directly towards that it is impossible to say, which of these is the
the differences in individuals in respect of their strongest factor. So, heredity and environment are
color of the skin, eyes and shape, composition complementary and not conflicting factors. Nature
and working of various internal as well as and nurture are equally important.
182 Psychology for Nurses

INDIVIDUAL DIFFERENCES IN HEALTH NURSING IMPLICATIONS OF

AND ILLNESS INDIVIDUAL DIFFERENCES
A very important aspect of understanding patients ™™ Knowledge of individual differences helps the
is to recognize and accept the fact of individual nurse to understand various reactions of patients
difference among patients. No two patients are alike. towards illness. In clinical practice the nurse will
They are different from each other intellectually, observe patients behaving differently. Nurse with
emotionally and socially. The causes for these the knowledge of individual differences can very
individual differences are: well-under­ stand the reason for differences in
 Hereditary factors their reactions towards illness.
 Culture ™™ This knowledge helps the nurse to provide
 Educational level individualized care to the patients.
 Socioeconomic status ™™ In educational set up, understanding of individual
 Age differences helps in planning course material and
 Occupation training program. The knowledge of individual
 Coping factors differences helps the nurse educators to recognize
 Nature and type of illness, etc. that all students do not learn in a similar way,
some are fast learners, others are slow, some can
Due to these Variations concentrate for long hours, other require more
™™ Some patients are cooperative and friendly and frequent rest periods, etc.
react in a cordial manner, while others remain ™™ Similarly all teachers are not alike; some have
aloof and in some extreme cases, antagonistic. good expression and ability to explain, while
™™ Some patients appear worried, tense and some do not.
apprehensive, while others are by nature cheerful ™™ Understanding of individual differences of the
and appear to be reasonably con­tended. teachers and the learners can help in matching
™™ Some patients understand quickly and res­pond to teaching and learning styles for better aca­demic
instructions readily, while others do not follow results.
instructions at all.
™™ Some patients are selfish and demanding asking REVIEW QUESTIONS
for attention.
™™ Some patients are very sensitive to pain and Long Essays
discomfort. They remain tense and appre­ 1. What is the nature and cause of individual
hensive and do not relax easily. Hence they do differences? (May 2007)
not cooperate well during their treatment. On 2. Explain heredity and environment and dis­cuss their
role in causing individual diffe­rences. (Nov 2003)
other hand some remain calm and show little
apprehension. They face the reality boldly.
™™ Some patients express their problems dra­ Short Essays
matically and are more or less childish and 1. Explain the role of environment in causing individ-
immature. They crave for attention and sympathy ual differences. (Oct 2007)
2. Nursing implications of individual diffe­rences.
from others.
3. Describe individual differences in illness—Role of
™™ Each of these patients requires special and indi­ a nurse.
vidualized nursing care. It is only a sym­pathetic
and understanding nurse who can make the
Short Answer
necessary adjustments, which meet these indi­
vidual differences. 1. Individual differences. (Apr 2005)
Glossary

A Adolescence
The period of life from puberty to the completion of
Ability physical growth.
A general term referring to the potential for acqui-
sition of a skill; the term covers intelligence and Alarm Reaction
specific aptitudes. The first stage of the general adaptation syndrome;
consists of prompt responses of the body, many of
Abnormal Behavior them mediated by the sympathetic system, which
Behavior which deviates from what is considered prepare the organism to cope with stressors.
normal; usually refers to maladaptive behavior.
All-or-none Law
Absolute Threshold Principle that nerve fibers respond completely or not
The smallest intensity of a stimulus that must be at all.
present for the stimulus to be detected.
Altruism
Accommodation, Visual Helping behavior that is beneficial to others, but
A process by which the lens of the eye varies its clearly requires self-sacrifice.
focus. In Piaget’s theory of cognitive development,
it refers to the process by which an infant modifies Amnesia
a pre-existing schema in order to include a novel Generally, any loss of memory; often applied to
object or event. situations in which a person forgets his or her own
identity and is unable to recognize familiar people
Achievement Motive and situations.
An urge to succeed, to perform well or better than
others. Anal Stage
According to Freud, a stage from 12 to 18 months to
Achievement Test 3 years of age, in which a child’s pleasure is centered
A test designed to determine a person’s level of on the anus.
knowledge in a given subject area.
Antisocial Personality Disorder
Adaptation A disorder in which individuals tend to display no
An adjustment in sensory capacity following pro- regard for the moral and ethical rules of society or
longed exposure to stimuli. the rights of others.
184 Psychology for Nurses

Anxiety Beliefs
A state of apprehension, tension and worry. Cognitions or thoughts about the characteristics of
objects.
Approach-approach Conflict
Conflict in which a person must choose between two C
good things.
Cannon-Bard Theory of Emotion
Approach-avoidance Conflict
A belief that both physiological and emotional
Conflict in which the person feels both positively and arousal are produced simultaneously by the same
negatively about the goal. nerve stimulus.
Aptitude Case Study
Specific ability indicative of one’s potentiality to get An in-depth, intensive investigation of an individual
desired future success. or small group of people.
Attention Catharsis
Concentration of mental activity. A process involving the release of emotional tension
Attitudes through expression of emotion.

Learned predispositions to respond in a favorable or Central Nervous System (CNS)

unfavorable manner to a particular person, behavior, A central nervous system that includes the brain and
belief or thing. spinal cord.
Attribution Central Traits
A process by which we attempt to explain the Major traits considered in forming impressions of
behavior of other people. Attribution theory deals others.
with the rules people use to infer the causes of
Cerebellum
observed behavior.
Part of the brain close to the brainstem, responsible for
Autocratic Leadership body balance and coordination of body movements.
Leadership, in which the leader holds most authority Cerebral Cortex
and closely controls choices.
The ‘new brain’, responsible for the most sophisti-
Avoidance-avoidance Conflict cated information processing in the brain; contains
A situation in which an individual is caught the lobes.
between two negative goals; as the individual tries Cerebrum
to avoid one goal, he or she is brought closer to
Largest part of the brain composed of two cerebral
the other.
hemispheres, left brain and the right brain.
Character
B
A judgment of an individual based upon certain
Behavior qualities usually related to a value system.
Anything a person or animal does that can be Chromosomes
observed in some way.
Rod-shaped structures that contain the basic
Behavior Modification hereditary information.
Change in behavior brought about by operant Chronological Age
conditioning techniques. Age in years or calendar age.
 Glossary 185
Classical Conditioning cutegroization of ideas helps people to plan and
A type of learning in which a neutral stimulus comes understand new information.
to bring about a response after it is paired with a Conditioned Response (CR)
stimulus that naturally brings about that response.
The learned or acquired response to a stimulus that
Clinical Psychology did not evoke the response originally.
A branch of psychology concerned with psychologi- Conditioned Stimulus (CS)
cal methods of recognizing and treating psychologi-
cal disorders and research into their causes. A previously neutral stimulus that comes to elicit a
conditioned response through association with an
Cognitive Approaches of Motivation unconditioned stimulus.
A theory suggesting that motivation is a product of
Conflict
people’s thoughts and expectations—their cognitions.
Conflict means a painful emotional state which results
Cognitive Development from a tension between opposed and contradictory
The process by which a child’s understanding of the wishes.
world changes as a function of age and experience.
Conformity
Cognitive Psychology
A change in behavior or attitude brought about by
A branch of psychology that focuses on the study of a desire to follow the beliefs or standards of other
cognition. people.
Cognitive-behavioral Approach Consciousness
An approach used by cognitive therapists that The awareness of the sensations, thoughts and
attempts to change the way people think through the feelings being experienced at a given moment.
use of basic principles of learning.
Continuous Reinforcement Schedule
Cognitive-social Learning Theory
Reinforcement of behavior every time it occurs.
A study of thought processes that underlie learning.
Collective Unconscious Control Group
A set of influences we inherit from our own particular A group that receives no treatment in an experiment.
ancestors, the whole human race and even animal Convergent Thinking
ancestors from the distant evolutionary past.
The ability to produce responses that are based
Community Psychology primarily on knowledge and logic.
A branch of psychology that focuses on the prevention
Coping
and minimization of psychological disorders in the
community. Efforts to control, reduce or learn to tolerate the
threats that lead to stress.
Compliance
Conforming behavior that occurs in response to Counseling
direct social pressure. Counseling is a process of enabling the individual
to know himself and his present and possible future
Concept situations, in order, that he may make substantial
Concept is an idea or a group of ideas used to contributions to the society and solve his own
orgnize events and objects, often arranged in hie- problems through a face-to-face personal relationship
rarchical order from general to more specific. Such with the counselor.
186 Psychology for Nurses

Creativity Dissociative Amnesia

The combining of responses or ideas in a novel way. A disorder in which the person has significant,
selective memory loss.
Crystallized Intelligence
Divergent Thinking
The accumulation of information, skills and strate-
gies learned through experience that can be applied The ability to generate unusual, yet appropriate
in problem-solving situations. responses to problems or questions.
Dominant Gene
D A gene with the capacity to express itself wholly, to
Decay the exclusion of the other member of the gene pair.
The loss of information in memory through its non-use. Double Approach-avoidance Conflict
A conflict in which the person has both negative and
Declarative Memory
positive feelings about either choice.
Memory for factual information: names, faces, dates
and the like. Down Syndrome
Severe mental retardation caused by an extra
Defence Mechanisms chromosome in a faulty egg at the time of conception.
Strategies that people use to deal with anxiety, which
Drive
are largely unconscious.
Motivational tension or arousal, that energizes
Dendrites behavior in order to fulfill some need.
A cluster of fibers at one end of a neuron that receive
Drive Theories
messages from other neurons.
Theories of motivation that emphasize the role of
Dependent Variable internal factors.
The variable that is measured and is expected
to change as a result of changes caused by the E
experimenter’s manipulation.
Eclectic Approach to Therapy
Developmental Psychology
An approach to therapy that uses techniques taken
The branch of psychology that studies the patterns of from a variety of treatment methods, rather than just
growth and change occurring throughout life. one method.
Difference Threshold Ego
The smallest level of stimulation required to sense The part of the personality that provides a buffer
that a change in stimulation has occurred. between the id and the outside world.
Discrimination Egocentric Thought
Negative behavior towards members of a particular A way of thinking in which the child views the world
group. entirely from his or her own perspective.
Displacement Ego Integrity Versus Despair Stage
A defence mechanism through which a person vents According to Erikson, a period from late adulthood
negative feelings against a substituted acceptable until death during which we review our life’s
object. accomplishments and failures.
 Glossary 187
Emotional Intelligence Explicit Memory
The set of skills that underlie the accurate assessment, Intentional or conscious recollection of information.
evaluation, expression and regulation of emotions.
Extinction
Emotions The decrease in frequency and eventual disappear-
It is a feeling state involving thoughts, physiological ance, of a previously conditioned response; one of
changes and an outward expression or behavior. the basic phenomena of learning.
Endocrine Gland Extrasensory Perception (ESP)
A ductless gland, which secretes hormones into the The supposed ability of some people to gain
bloodstream. knowledge about the world through avenues other
Episodic Memory than the sensory channels.
Episodic memory is a category of long-term Extrinsic Motivation
declarative memory that involves the recollection
Motivation directed towards goals, external to the
of specific events, situations and experiences. In
person.
addition to the overall memory of the event itself, it
also involves memory of the location and time that Extrovert
the event occurred. Jung’s term to describe a personality that focuses
Esteem Needs on social life and the external world instead of its
In Maslow’s theory, needs for prestige, success and internal experience.
self-respect; they can be fulfilled after belongingness
and love needs are satisfied. F
Evolutionary Psychology Figure-ground Relationship
The branch of psychology that seeks to identify Perception typified by one feature standing out
behavior patterns that are a result of our genetic against a larger background.
inheritance from our ancestors.
Fixation
Experiment
In psychoanalytic theory, failure of some personality
The investigation of the relationship between two (or
characteristics to advance beyond a particular stage
more) variables by deliberately producing a change
of psychosexual development.
in one variable in a situation and observing the effects
of that change on other aspects of the situation. Fixed Interval Schedule
Experimental Bias A schedule that provides reinforcement for a
Factors that distort the manner in which the response only if a fixed time period has elapsed,
independent variable affects the dependent variable making overall rates of response relatively low.
in an experiment. Fixed Ratio Schedule
Experimental Group A schedule whereby reinforcement is given only
Any group receiving a treatment in an experiment. after a certain number of responses are made.

Experimental Manipulation Fluid Intelligence

The change that an experimenter deliberately pro- Intelligence that reflects information processing
duces in a situation. capabilities, reasoning and memory.
188 Psychology for Nurses

Forgetting Genes
Apparent loss of information that has been stored in The parts of the chromosomes through which genetic
long-term memory (LTM). information is transmitted.
Fraternal Twins Genital Stage
Twins who develop from two different fertilized eggs, According to Freud, the period from puberty until
and who consequently are different in hereditary death, marked by mature sexual behavior (i.e. sexual
characteristics as ordinary brothers and sisters. Also intercourse).
called dizygotic (DZ) twins.
Gestalt (ge. stalt) Psychology
Free Association An approach to psychology that focuses on the
A psychoanalysis technique in which the patient organization of perception and thinking in a ‘whole’
expresses whatever comes into his mind for revealing sense, rather than on the individual elements of
his unconscious. perception.
Frustration Gestalt Laws of Organization
Blocking of goal-directed behavior. A series of principles that describe how we organize
bits and pieces of information into meaningful wholes.
Functional Fixedness
Gestalt Therapy
The tendency to think of an object only in terms of
its typical use. An approach to therapy that attempts to integrate a
client’s thoughts, feelings and behavior into a unified
Functionalism whole.
An early approach to psychology that is concentrated Group Therapy
on what the mind does functions of mental activity
Therapy in which people discuss problems in a
and the role of behavior in allowing people to adapt
group.
to their environments.
Fundamental Attribution Error H
A tendency to attribute others behavior to disposi-
Health Psychology
tional causes and the tendency to minimize the im-
portance of situational causes. The branch of psychology that investigates the
psychological factors related to wellness and illness,
including the prevention, diagnosis and treatment of
G
medical problems.
Galvanic Skin Response Homeostasis
A change in electrical resistance of the skin that may A state of physiological equilibrium that is main-
occur during many emotions. tained by innate and automatic regulatory mecha-
nisms.
General Adaptation Syndrome (GAS)
A theory developed by Selye that suggests that a Hormones
person’s response to stress consists of three stages: Chemicals that circulate through the blood and affect
alarm, resistance and exhaustion. the functioning or growth of other parts of the body.
Generativity Humanistic Approaches to Personality
According to Erikson, to take an interest in guiding The theory that people are basically good and tend to
the next generation. grow to higher levels of functioning.
 Glossary 189
Hypnosis Industrial Organizational (I/O) Psychology
A trance like state of heightened susceptibility to the The branch of psychology that focuses on work
suggestions of others. and job-related issues, including productivity, job
satisfaction, decision making and consumer behavior.
I Industry Versus Inferiority Stage
Id According to Erikson, the last stage of childhood,
A concept in Freudian psychology that relates with during which children (aged 6 to 12 years) either
unconscious, amoral and irresponsible personality. develop positive social interactions with others or
It functions on the pleasure principle and is the feel inadequate and become less sociable.
reservoir of instincts. Infancy
Identification The period of development between the neonatal
The process of trying to be like another person as period and the appearance of useful language; the
much as possible, imitating that person’s behavior upper limit is about 18 months.
and adopting similar beliefs and values. Integrity
Identity Versus Role Confusion Stage According to Erikson, a state of fulfillment and
It is the fifth stage of Erik Erikson's theory of psy- completeness.
chosocial development; occurs during adolescence
Intellectualization
between the ages of approximately 12 to 18. At this
stage, adolescents are in search of an identity to de- A defence mechanism in which a person reduces
termine one’s unique qualities that will lead them to anxiety by thinking of the anxiety producing situation
adulthood. in unemotional or abstract terms.

Implicit Memory Intelligence

Implicit memory also known as unconscious or non- The ability to learn from experience, think in abstract
declarative memory is a type of memory in which terms and deal effectively with one’s environment.
previous experiences aid in the performance of a
Intelligence Quotient (IQ)
talk without conscious awareness of these previous
experiences. A measure of intelligence. It is equal to a person’s
mental age divided by chronological age and
Incentive multiplied by 100.
A kind of reward that reinforces the behavior in its
Intelligence Tests
own right.
Tests devised to identify a person’s level of intelli-
Incentive Approaches to Motivation gence.
The theory suggesting that motivation stems from the
Interference
desire to obtain valued external goals or incentives.
The phenomenon by which information in memory
Independent Variable displaces or blocks out other information, preventing
The variable that is manipulated by an experimenter. its recall.
Inductive Reasoning Interference Theory of Forgetting
The logical process by which general principles are The theory of forgetting holding that we forget things
inferred from particular instances. because other knowledge gets in the way.
190 Psychology for Nurses

Intimacy Versus Isolation Stage Learning

According to Erikson, a period during early adult- Relatively permanent changes in the behavior of the
hood that focuses on developing close relationships. learner brought about by experience or training.
Intrinsic Motivation Learning Theory Approach
Desire to perform an activity for its own sake. The theory suggesting that language acquisition fol-
lows the principles of reinforcement and conditioning.
Introspection
A procedure used to study the structure of the mind, Libido
in which subjects are asked to describe in detail what A concept in Freud’s psychology denoting the basic
they are experiencing when they are exposed to a sexual drive or instinct responsible for every aspect
stimulus. of a person’s behavior.
Introvert Life Review
A shy person who usually withdraws and prefers to The process in which people in late adulthood
be alone. examine and evaluate their lives.
Limbic System
J A group of closely interconnected structures at the
James-Lange Theory of Emotion core of the brain that works with the hypothalamus
to control the emotions and motivational processes.
The theory states that the stimulus first leads to bodily
responses and then the awareness of these responses Long-term Memory
constitutes the experience of emotion. Memory that stores information on a relatively
permanent basis, although it might be difficult to
L retrieve.
Laissez-Faire Leadership
M
Leadership in which the leader has poorly defined
lines of authority and responsibility often allowing Maturation
people to do as they please. The changes in behavior of an organism resulting
from physiological growth, the blueprints of which
Language
are provided by heredity.
Communication in which word symbols are used in
various combinations to convey meaning. Medulla
The part of the hindbrain that regulates breathing,
Latency Period
heart rate and blood pressure.
According to Freud, the period between the phallic
stage and puberty during which children temporarily Memory
put aside their sexual interests. The process by which we encode, store and retrieve
information.
Latent Learning
Learning, in which a new behavior is acquired, but Memory Trace
is not demonstrated until reinforcement is provided. A physical change in the brain that occurs when new
material is learned.
Learned Helplessness
A condition of apathy or helplessness created Mental Age
experimentally by subjecting an organism to The average age of individuals who achieve a
unavoidable trauma such as shock, heat or cold. particular level of performance in a test.
 Glossary 191
Mental Retardation Myelin Sheath
Having significantly below average intellectual Specialized cells of fat and protein that wrap
functioning and limitations in at least two areas of themselves around the axon, providing a protective
adaptive functioning. coating.
Midbrain
N
Area of the brain that controls auditory and visual
responses. Naturalistic Observation
Minnesota Multiphasic Personality A psychological method of studying behavior by
Inventory (MMPI) observing the subjects in their natural settings.
A pencil and paper version of a psychiatric Need
interview that consists of more than 550 statements
Deprivation caused by a lack of something necessary
concerning attitudes, emotional reactions, physical
to survival or well being.
and psychological symptoms and experiences. Test
takers respond to each statement by answering, Need for Achievement
‘True’, ‘False’ or ‘Cannot Say’. A stable, learned characteristic in which satisfaction
Modeling is obtained by striving for attaining a level of
excellence.
A type of imitation in which one individual does
what he/she sees his/her model doing. Need for Affiliation
Morale An interest in establishing and maintaining
relationships with other people.
A positive group feeling of satisfaction and
enthusiasm for a task. Need for Power
Motivation A tendency to seek impact, control or influence over
The factors that direct and energize the behavior of others, and to be seen as a powerful individual.
humans and other organisms. Need Reduction
Motivational Cycle The satisfaction of one’s biological or socio-
A cycle including arousal of the motive, goal- psychological needs.
directed behavior and satisfaction. Negative Reinforcer
Motor (Efferent) Neurons An unpleasant stimulus whose removal leads to an
Neurons that communicate information from the increase in the probability that a preceding response
nervous system to muscles and glands of the body. will occur again in the future.

Motor Area Neo-Freudian Psychoanalysts

The part of the cortex that is largely responsible for Psychoanalysts who were trained in traditional
the voluntary movement of particular parts of the Freudian theory but who later rejected some of its
body. major points.
Multiple Approach-avoidance Conflict Nerve Fiber
A motivational conflict in which several incompatible An axon or dendrite of a neuron, many of which
positive and negative goals are involved; together form a nerve, transmitting nerve impulses
characteristic of many of life’s major decisions. to and from the central nervous system.
192 Psychology for Nurses

Nervous System Parasympathetic System

Central control system of the body, which organizes The part of the autonomic nervous system, which
and coordinates the functions of the organism. tends to be active when we are calm and relaxed;
builds up and conserves the body’s store of energy.
Neural Stimulus
A stimulus that, before conditioning, does not Perception
naturally bring about the response of interest. A process of organizing environmental stimuli into
some meaningful patterns or wholes.
Neurotransmitters
Chemicals that carry messages across the synapse Perceptual Constancy
to the dendrite (and sometimes the cell body) of a A tendency to perceive the stimuli in the environment
receiver neuron. as unchanging, though in reality there may be
changes in shape, size or other characteristics.
Norm
A rule which guides behavior. Peripheral Nervous System
The part of the nervous system that includes the
O autonomic and somatic subdivisions made up of
long axons and dendrites, it branches out from the
Obedience spinal cord and brain and reaches the extremities of
Conforming behavior in reaction to the commands the body.
of others. Personality
Observational Learning The pattern of enduring characteristics that
Learning through observing the behavior of another differentiates a person—the patterns of behaviors
person. that make each individual unique.

Oedipus Conflict Personality Disorder

A child’s sexual interest in his or her opposite-sex A mental disorder characterized by a set of inflexible,
parent, typically resolved through identification with maladaptive personality traits that keep a person
the same sex parent. away from functioning properly in society.

Operant Conditioning Personality Inventory

Learning in which a voluntary response is An inventory for self-appraisal, consisting of many
strengthened or weakened, depending on its statements or questions about personal characteristics
favorable or unfavorable consequences. and behavior that the person judges to apply or not to
apply to him or her.
Oral Stage
Persuasion
First stage in Freud’s psychoanalytic theory of
personality; during first 18 months of life in which The act of giving information, which causes a person
intense pleasures are derived from activities that to do or believe something.
involve the mouth. Phallic Stage
According to Freud, a period beginning around
P age 3 during which a child’s interest focuses on the
Paresthesia genitals.

A condition in which a person experiences false Phobias

sensations. Intense, irrational fears of specific objects or situations.
 Glossary 193
Pituitary Gland Psychoanalytic Theory
The ‘master gland,’ the major component of the Freud’s theory that unconscious forces act as
endocrine system, which secrets hormones that determinants of personality.
control growth.
Psychodynamic Perspective
Pleasure Principle The approach based on the belief that behavior is
A principle in Freudian theory emphasizing motivated by unconscious inner forces over which
the immediate gratification regardless of the the individual has little control.
consequences, a function of the id. Psychology
Positive Reinforcer The scientific study of behavior and mental processes.
A stimulus added to the environment that brings Psychosexual Stages
about an increase in a preceding response. The five stages of psychological development as put
Positive Transfer by Freud in his personality theory.
A type of transfer in which one learning helps Psychosocial Development
facilitate the other learning. Development of individuals’ interactions and
Preconscious understanding of each other and of their knowledge
and understanding of themselves as members of
Memories and thoughts of which a person is not society.
aware at a particular time, but which may easily
become conscious. Psychosomatic Illness
A condition in which emotional stress causes
Prejudice
physical illness.
An unjustified attitude, fairly strong, usually in an
unfavorable direction and not in line with the facts. Psychotherapy
Treatment in which a trained professional, a therapist,
Proactive Interference uses psychological techniques to help someone
Forgetting caused by the prior learning of other overcome psychological difficulties and disorders,
material. resolve problems in living or bring about personal
growth.
Projection
Punishment
A defense mechanism in which conflict is dealt with
ascribing one’s own anxiety-provoking motives to A stimulus which decreases the probability that a
someone else; blaming others; prominent in paranoid previous behavior will occur again.
disorders.
R
Projective Personality Test
A test in which a person is shown an ambiguous Rationalization
stimulus and asked to describe it or tell a story about it. A defence mechanism through which a person gives
false reasons for his behavior.
Proximity
A principle of perceptual organization stating that Reaction Formation
nearness or closeness of objects leads the perceiver A defence mechanism through which a person stro-
to perceive them in patterns. ngly expresses the reverse of what he feels.
194 Psychology for Nurses

Recall Rorschach Test

The process of remembering without the aid of extra A test developed by Swiss psychiatrist Hermann
cues. Rorschach that consists of showing a series of
symmetrical stimuli to people and then asking them
Recessive Gene to say what the figures represent to them.
Gene whose hereditary potential is not expressed
when it is paired with a dominant gene. S
Recognition Schachter-Singer Theory of Emotion
The ability to look at several things and select one The belief that emotions are determined jointly by
that has been seen or learned before. a non-specific kind of physiological arousal and its
Reflex interpretation, based on environmental cues.
Involuntary, unlearned, immediate response to a Schedules of Reinforcement
stimulus. The frequency and timing of reinforcement following
Regression desired behavior.
A defence mechanism in which a person copes with Schemas
anxiety by retreating to childish or earlier forms of Organized bodies of information stored in memory
behavior; often encountered in children and adults that bias the way new information is interpreted,
faced with frustration and motivational conflict. stored and recalled.
Reinforcement Scientific Method
The process of strengthening a response with the The approach used by psychologists to systematically
help of an appropriate stimulus making it more likely acquire knowledge and understanding about behavior
to recur. and other phenomena of interest.
Reinforcer Self-actualization
Any stimulus that increases the probability that a According to Rogers, a state of self-fulfillment in
preceding behavior will occur again. which people realize their highest potential; the
highest need in the hierarchical structure of needs
Repression proposed by Maslow, that drives an individual to
A defense mechanism through which a person discover one’s self and fulfill one’s potential.
unconsciously forgets unpleasant experiences.
Self-concept
Retention The general ideas and feelings that one acquires about
Storage of learned material in memory. himself as a unique individual of special significance.
Reticular Activating System (RAS) Self-esteem
Nervous system structure running through the hind- Self-esteem often seen as a personality trait is used
brain and midbrain to the hypothalamus responsible to describe a person’s overall sense of self-worth
for general arousal of the organism. or personal value. It involves a variety of beliefs
about the self, such as the appraisal of one’s own
Retrograde Amnesia
appearance, beliefs, emotions and behaviours.
Forgetting events one was exposed to in the past.
Semantic Memory
Role Memory for general knowledge and facts about the
A behavior pattern expected from a person in a world, as well as memory for the rules of logic that
certain social position. are used to deduce other facts.
 Glossary 195
Sensation Stimulus
The processes by which our sense organs receive The physical energy or action, which causes a
information from the environment. response from an organism.
Sensory Memory Stimulus Discrimination
The initial, momentary storage of information, A concept in the theory of conditioning emphasizing
lasting only an instant. that an organism learns to react to differences in
Shaping stimuli and to distinguish between them.
The process of teaching a complex behavior by Stimulus Generalization
rewarding closer and closer approximations to A concept in the theory of conditioning emphasizing
the desired behavior, it is a technique in operant that once an organism gets conditioned to respond to
conditioning. a specific stimulus, other, similar stimuli bring the
Short-term Memory (STM) same response.
The type of memory helpful in retaining several Stimulus Variability
items of information for about 20 seconds or so even
Innate performance for change in environmental
if one gets no chance to rehearse or repeat them.
stimuli.
Skill
Stress
The ability to perform a specialized activity well.
The response to events that are threatening or
Social Motives challenging.
Motives, usually learned in a social group, that Structuralism
require the presence or reaction of other people for
their satisfaction. Wundt’s approach, which focuses on the basic
elements that form the foundation of thinking,
Social Psychology consciousness, emotions and other kinds of mental
The study of how people’s thoughts, feelings and states and activities.
actions are affected by others.
Sublimation
Somatoform Disorder
A defense mechanism through which a person directs
A behavioral disorders in which a person shows unacceptable desires into acceptable behavior.
physical symptoms for which no physical cause can
be found. Superego

Somatotyping According to Freud, the final personality structure

to develop; it represents society’s standards of right
Sheldon’s system of classifying persons into certain and wrong as handed down by a person’s parents,
body types according to the degree to which their teachers and other important figures.
somatic structure (body build) reflects certain
physical characteristics. Suppression
Spontaneous Recovery The act of consciously putting aside unacceptable
The recovery of part of the strength of a conditioned feelings and desires.
response some time after it has been extinguished. Synapse
Stereotypes Fluid-filled space between the axon of one neuron
Generalized beliefs and expectations about social and the receiving dendrite of the next that helps the
groups and their members. flow of information through the nervous system.
196 Psychology for Nurses

T Transference
In psychoanalysis, the process by which the patient
Temperament transfers a variety of positive and negative reactions
The hereditary emotional aspects of one’s personality. associated with parents and other childhood
Temporal Lobes authority figures, directing these feelings towards
the therapist.
Parts of the cerebrum at the sides of the head mainly
responsible for hearing. Trust Versus Mistrust Stage
Thalamus According to Erikson, the first stage of psychosocial
development, occurring from birth to 18 months of
The egg-shaped part of the forebrain, which age, during which time infants develop feelings of
relays sensory information and controls sleep and trust or lack of trust.
wakefulness.
Type A Behavior Pattern
Thematic Apperception Test (TAT)
A pattern of behavior characterized by competiti­
A test consisting of a series of ambiguous pictures veness, impatience, tendency toward frustration and
about which the person is asked to write a story. hostility.
Theories Type B Behavior Pattern
Broad explanations and predictions concerning A pattern of behavior characterized by cooperation,
phenomena of interest. patience, non-competitiveness and non-aggression.
Thinking
Thinking is the processing of information mentally U
or cognitively by rearranging the information from
Unconditional Positive Regard
the environment and the symbols stored in the past
memory. An attitude of acceptance and respect on the part of
an observer, no matter what the other person says or
Thyroid Gland does.
Endocrine gland located below the larynx that
Unconditioned Response (UCR)
secretes thyroxin, which controls metabolism.
A response that is natural and needs no training (e.g.
Trait salivation at the smell of food).
Particular feature of an individual’s personality that
Unconditioned Stimulus (UCS)
seems to stand out and endure over a vide variety of
situations. A stimulus that brings about a response without
having been learned.
Trait Theory
Unconscious
A model of personality that seeks to identify the
basic traits necessary to describe personality. A part of the personality of which a person is not
aware and which is a potential determinant of
Transactional Analysis (TA) behavior.
Altering one’s state of consciousness by focusing on
one’s breathing, while excluding all other thoughts. V
Transduction
Variable-interval Schedule
Process by which receptor cells transform physical
energy into an impulse that the nervous system can A schedule whereby the time between reinforcements
carry. varies around some average rather than being fixed.
 Glossary 197
Variable-ratio Schedule W
A schedule whereby reinforcement occurs after a
varying number of reasons rather than after a fixed Withdrawal
number. A defense mechanism through which a person
Variables physically avoids unpleasant situations.
Behaviors, events or other characteristics that can Working Memory
change or vary in some way.
Memory that is stored for only a few seconds.
Verbal Behavior
The use of spoken or written language in communi- Z
cating with others.
Visual Acuity Zygote
Ability to distinguish fine details in the field of vision. A new cell formed by the union of an egg and sperm.
Question Bank

CHAPTER 1 6. Understanding subject psychology is important

INTRODUCTION TO PSYCHOLOGY for a nurse because:
a. It helps the nurse to understand herself
1. Psychology is defined as the scientific study of:
b. It helps the nurse to understand others
a. Mental disorders
c. It helps the nurse to improve situations by
b. Various aspects of mental processes
solving problems
c. Various aspects of human relationships
d. All of the above
d. Human and animal behavior
7. Which of the following is the scientific method
2. Which of the following deals with the study of
of psychology?
how a person’s actions, feelings or thoughts are
a. Introspection method
influenced by others?
b. Observation method
a. Social psychology
c. Experimental method
b. Clinical psychology
d. Interview method
c. Educational psychology
8. What is introspection?
d. Health psychology
a. Self-motivation
3. What is general psychology?
a. That which deals with fundamental rules and b. Self-observation
principles of psychology c. Self-interest
b. That which deals with general behavior of d. Self-learning
people 9. The first step in the scientific method involves:
c. That which deals with general activities of an a. Replication of procedures
organism b. Formulating an explanation
d. That which deals with normal behavior of a c. Carrying out research
person d. Identifying questions of interest
4. Behavior includes which of the following 10. The purpose of the control group in an experiment
‘activities’? is to:
a. Motor a. Give a comparison that allows the independent
b. Cognitive variable to be judged
c. Affective b. Prevent the researcher from cheating
d. All of the above c. Accommodate the extra participants
5. Who is the father of psychology? d. Assist in the design of the research project
a. Sigmund Freud 11. Scientists who are most likely to study the
b. William James relationship between stress levels and an
c. Ivan Pavlov individual’s likelihood of contracting a disease
d. Wilhelm Wundt are _____________ psychologists.
200 Psychology for Nurses

a. Counseling CHAPTER 2
b. Health BIOLOGY OF BEHAVIOR
c. Cognitive
1. Which among the following is the basic unit of
d. Developmental
the nervous system?
12. Mental experiences operate on different levels
a. Brain
of awareness. The level that best portrays one’s
b. Neuron
attitudes, feelings and desires is the:
c. Spinal cord
a. Conscious
d. Axon
b. Unconscious
2. Which among the following is a part of the neuron
c. Preconscious that receives messages from other neurons?
d. Foreconscious a. Axons
13. Wundt described psychology as the study of b. Terminal buttons
conscious experience, a perspective he called c. Dendrites
____________. d. Cell bodies
14. Early psychologists’ studied the mind by asking 3. A narrow gap that separates the neurons is:
people to describe what they were experiencing a. Axon tip
when exposed to various stimuli. This procedure b. Cell body
is known as _____________. c. Synaptic cleft
15. The statement, “In order to study human behavior, d. None of the above
we must consider the whole of perception rather 4. Information is passed from one neuron to another
than its component parts” might be made by at synapses by:
a person subscribing to the ____________ a. Cell membrane
perspective. b. Neurotransmitters
16. Which perspective suggests that abnormal c. Nerve impulses
behavior is largely the result of unconscious d. None of the above
forces? 5. The part of the brain that regulates higher levels
17. “Psychologists should worry only about behavior of cognitive and emotional functions is the:
that is directly observable.” This statement would a. Cerebellum
most likely be made by a person using which b. Cerebrum
psychological perspective? c. Limbic system
18. The group in an experiment that receives no d. None of the above
treatment is called the ________ group. 6. The brain structure located in the center of the
19. ————— psychology describes the relation of brain, which has a role in emotions is:
physical environment with behavior. a. Cerebellum
20. ————— psychology explains physiological b. Limbic system
basis of behavior. c. Pituitary
d. Caudate nucleus
7. The following plays an important role in long-
KEY term storage of information:
1. d 2. a 3. a 4. d
a. Hypothalamus
5. d 6. d 7. c 8. b b. Thalamus
9. d 10. a 11. b 12. b c. Hippocampus
13. Structuralism 14. Introspection d. Amygdala
15. Gestalt 16. Psychodynamic 8. The cerebrum controls:
17. Behavioral 18. Control a. Cognitive functions
19. Geo 20. Physiological b. Motor functions
 Question Bank 201
c. Coordination a. Heredity versus environment
d. All of the above b. Education versus nutrition
9. What controls feeding, drinking, temperature c. Physical versus mental activity
regulation, sexual behavior, fighting or activity d. Learned versus unlearned behavior
level? 16. After a successful job interview, Mr Abhishek
a. Basal ganglia felt relaxed and calm, he stopped sweating and
b. Hypothalamus felt hungry, which part of his nervous system was
c. Thalamus activated?
d. Pituitary gland a. Sympathetic
10. The goal of physiological psychology is to b. Somatic
understand the function of the brain and its c. Parasympathetic
relation to: d. Central
a. Communication 17. How many chromosomes does a zygote contain?
b. Behavior a. 2
c. Biology b. 23
d. Neurotransmitters c. 46
11. Which of the following areas of the brain deals d. 92
with psychological processes like reasoning and 18. Which of the following factors supports the
memory? nurture argument?
a. Motor area a. Hereditary factors
b. Premotor area b Maturation
c. Association area c Genetic makeup
d. Sensory area d Environmental factors
12. Two parts of the autonomic nervous system are: 19. The central nervous system is composed of the
_______ and __________.
a. Brain and spinal cord
20. Each hemisphere controls the ___________ side
b. Somatic and parasomatic
of the body.
c. Anterior and posterior
21. Non-verbal realms, such as emotions and music,
d. Sympathetic and parasympathetic
are controlled primarily by the _________
13. Which of the following experiences do not easily
hemisphere of the brain, whereas the ______
reach to awareness?
hemisphere is more responsible for speaking and
a. Conscious
reading.
b. Preconscious
22. The left hemisphere tends to consider information
c. Unconscious
__________, whereas the right hemisphere tends
d. Semiconscious
to process information __________.
14. The study of the inheritance of physical and
psychological characteristics from ancestors is
KEY
referred to as:
a. Biopsychology 1. b 2. c 3. c 4. b
5. b 6. b 7. c 8. d
b. Genetics
9. b 10. b 11. c 12. d
c. Chromosomes 13. c 14. b 15. a 16. c
d. Anthropology 17. c 18. d
15. Another way of stating the nature versus nurture 19. Brain, spinal cord 20. Opposite
issue is: 21. Right, left 22. Sequentially, globally
202 Psychology for Nurses

CHAPTER 3 a. Voluntary attention

COGNITIVE PROCESSES b. Involuntary attention
c. Habitual attention
Sensation, Perception and Attention d. None of the above
8. A person busy writing an assignment hears a loud
1. Stimulus operating on our nervous system is sound and immediately attends to it, this is an
termed as: example of:
a. Sensation a. Involuntary attention
b. Observation b. Voluntary attention
c. Attention c. Habitual attention
d. Perception d. Partial voluntary attention
2. Which of the following factors influence an 9. Solving a mathematics problem is an example of:
individual’s perception? a. Voluntary attention
a Motives and needs b. Involuntary attention
b. Learning c. Habitual attention
c. Person’s mental set d. All of the above
d. All of the above 10. The maximum amount of material that can be
3. According to which of the principles, items attended to in one period of attention is called:
which are close together in space of time tend to a. Variety of attention
be perceived as belonging together or forming an b. Span of attention
organized group? c. Division of attention
a. Similarity d. None of the above
b. Proximity 11. The time range for visual span of attention is:
c. Good figure a. 1/100 to 1/5 of a second
d. Closure b. 1/200 to 1/10 of a second
4. A common type of perceptual error found in a c. 1/300 to 1/15 of a second
psychotic patient is: d. 1/400 to 1/20 of a second
a. Illusion 12. In visual span of attention at a brief glance how
b. Hallucination many units can be perceived?
c. Delusion a. 4 or 5 units
d. Thought disorder b. 6 or 7 units
5. Concentration of consciousness upon one object c. 7 or 8 units
rather than upon another is called: d. 8 or 9 units
a. Observation 13. Attending to two or more tasks simultaneously is
b. Sensation termed as:
c. Attention a. Visual span of attention
d. Perception b. Auditory span of attention
6. What is voluntary attention? c. Division of attention
a. It does not demand conscious effort on the d. Variety of attention
subject 14. When we travel in the train we attend to the
b. It demands the conscious effort on the subject scenery as well as to the talks of our companions,
c. It demands single act of will this is called:
d. It demands repeated acts of will a. Variety of attention
7. Certain situations neither demand any conscious b. Subjective factor of attention
effort nor strike to catch our attention but we still c. Objective factor of attention
attend to it. It is: d. Division of attention
 Question Bank 203
15. To achieve our goal we make deliberate effort Learning
and focus our conscious upon an object. It is
1. A relatively enduring behavioral change brought
termed as:
about by an experience is called:
a. Involuntary attention
a. Learning
b. Voluntary attention
b. Habituation
c. Habitual attention
c. Growth
d. Partially voluntary and partially involuntary
d. All of the above
attention
2. The process of learning:
16. Leakage of LPG gas in your house catches your
a. Improves adjustment
attention. It is an example of:
a. Involuntary attention b. Improves efficiency
b. Habitual attention c. Is continuous
c. Voluntary attention d. All of the above
d. None of the above 3. Which of the following is a factor that is not
17. The attention which makes you wish every time conducive to learning?
you see the teacher is an example of: a. Intelligence
a. Voluntary attention b. Motivation
b. Involuntary attention c. Distracting conditions
c. Habitual attention d. Good physical health
d. None of the above 4. Learning results in:
18. A skillful knitter who can knit and read at the a. A more or less permanent change in behavior
same time have learnt by long practice to knit b. Poor control of one's emotions
quite automatically is an example of: c. Frequent motivational conflicts
a. Visual span of attention d. All of the above
b. Auditory span of attention 5. Ivan Pavlov proposed the concept of:
c. Division of attention a. Operant conditioning
d. Variety of attention b. Classical conditioning
19. __________ is the stimulation of the sense organs; c. Learning by trial and error
_________ is the sorting out, interpretation, d. Learning by insight
analysis and integration of stimuli by our sense 6. In Pavlov's original experiment, meat was the:
organs. a. Unconditioned stimulus
20. The terms absolute threshold refers to the b. Conditioned stimulus
________ intensity of a stimulus that must be c. Unconditioned response
present for the stimulus to be detected. d. Conditioned response
21. When a car passes you on the road and appears to 7. You begin to salivate at the sight of a pizza hut
shrink as it gets farther away, the phenomenon of sign. When this happens, the sight of the sign is
__________ permits you to realize that the car is an example of:
not in fact getting smaller. a. Unconditioned stimulus
b. Discriminative stimulus
KEY c. Conditioned stimulus
d. Conditioned response
1. a 2. d 3. b 4. b
5. c 6. b 7. c 8. a
8. In classical conditioning, the __________ becomes
9. a 10. b 11. a 12. a capable of eliciting a response previously triggered
13. c 14. d 15. b 16. a by the unconditioned stimulus.
17. c 18. c 19. Sensation, perception a. Aversive stimulus
20. Smallest 21. Perceptual constancy b. Conditioned stimulus
204 Psychology for Nurses

c. Secondary reinforcer c. Continuous basis

d. Primary reinforcer d. Fixed-ratio reinforcement basis
9. Extinction occurs in classical conditioning: 16. Trial and error learning was propagated by:
a. After repeated trials wherein the conditioned a. Erikson
stimulus is presented by itself b. Pavlov
b. When the delay between the conditioned c. Thorndike
stimulus and the unconditioned stimulus is d. Skinner
decreased to approximately half a second 17. Zero transfer is also known as:
c. When the unconditioned stimulus loses its a. Negative transfer
ability to elicit the unconditioned response b. Neutral transfer
d. When the conditioned stimulus and the c. Unilateral transfer
unconditioned stimulus are paired on every trial d. Positive transfer
10. According to behavioral view of learning: 18. Learning involves changes brought about by
a. Human beings can be taught to do anything experience, whereas ___________ describes
b. Human learning cannot be modified changes due to biological development.
c. Human learning is rigid 19. In a _______ reinforcement schedule, behavior
d. None of the above is reinforced some of the time, while in a
11. BF Skinner proposed the concept of: ___________ reinforcement schedule, behavior
a. Operant conditioning
is reinforced all the time.
b. Classical conditioning
20. Cognitive-social learning theorists are concerned
c. Learning by trial and error
only with overt behavior, not with its internal
d. Learning by insight
cause. True or False ?
12. Adding something pleasant is ____________
21. Bandura's theory of ___________ learning states
and removing something good is __________
that people learn through watching a ________;
a. Positive reinforcement; negative reinforcement
another person displaying the behavior of
b. Positive reinforcement; punishment by removal
c. Negative reinforcement; punishment by appli- interest.
cation 22. A man wishes to quit smoking. Upon the advice
d. Punishment; reinforcement of a psychologist, he begins a program in which
13. Someone who offers money in the temple every he sets goals for his withdrawal, carefully records
week is doing so according to a ____________ his progress and rewards himself for not smoking
reinforcement schedule. during a certain period of time. What type of
a. Fixed-interval program is he following?
b. Variable-interval
c. Fixed-ratio KEY
d. Variable-ratio
1. a 2. d 3. c 4. a
14. Rewards that satisfy a biological need are called:
5. b 6. a 7. a 8. b
a. Negative reinforcers
9. c 10. a 11. a 12. a
b. Positive reinforcers 13. a 14. d 15. b 16. c
c. Secondary reinforcers 17. b 18. Maturation 19. Partial, continuous
d. Primary reinforcers 20. False, cognitive-social learning theorists are primarily
15. Prizes in lotteries are given on a: concerned with mental processes
a. Variable-interval reinforcement basis 21. Observational, model
b. Variable-ratio reinforcement basis 22. Behavior modification
 Question Bank 205
Memory 9. Which of the following components of memory
1. In psychology, which of the following mental system refers to the transformation of a physical
processes provides the basis for all cognitive stimulus into a form that human memory accepts?
processes? a. Encoding
a. Thinking b. Storage
b. Learning c. Retrieval
c. Memory d. Recognition
d. Motivation 10. Which of the following types of long-term mem-
2. The first stage of memory is: ory deals with individual's personal experiences?
a. Encoding a. Semantic memory
b. Storage b. Episodic memory
c. Retrieval c. Procedural memory
d. Imagination d. All of the above
3. Short-term memory is also known as: 11. Which of the following is a center for recent
a. Iconic memory memory?
b. Working memory a. Temporal lobe
c. Echoic memory b. Parietal lobe
d. Sensory memory c. Hippocampus
4. Long-term memories may last for: d. Thalamus
a. Days 12. Partial or complete loss of memory is called:
b. Months a. Agnosia
c. Years b. Ataxia
d. All of the above c. Amnesia
5. Memory images or traces are present in the mind d. Forgetting
in the form of: 13. An amnesia in which there is total failure of
a. Pictures
memory for events that happened before the
b. Engrams
trauma that produced the memory impairment is
c. Signals
called:
d. Diagrams
a. Anterograde amnesia
6. Which of the following type of memory helps an
b. Retrograde amnesia
individual to recall something a split second after
c. Transient amnesia
having perceived it?
a. Short-term memory d. Functional amnesia
b. Immediate or sensory memory 14. Most evidence suggests that memory loss in
c. Long-term memory older adults:
d. Delayed memory a. Is not an inevitable part of the aging process
7. Semantic memory is memory for: b. Is genetically preprogrammed
a. Language and knowledge c. Usually affects all memory functions of the
b. Visuospatial orientation individual
c. Events occurring in one's life d. Is caused by senility
d. Events occurring in external world 15. When new memories interfere in the retrieval of
8. Which of the following is a measure of memory? old memory, it is called:
a. Recall or reproduction a. Proactive interference
b. Recognition b. Saving
c. Repetition c. Retroactive interference
d. Registration d. Implicit memory
206 Psychology for Nurses

16. A professor forgets the names of students who c. Both a and b

attended her class two semesters ago because d. None of the above
she learned the names of all the students this 3. In which of the following we use system of
semester. This is an example of the memory symbols to communicate with each other?
problem’s called: a. Perception
a. Alzheimer disease b. Concepts
b. Decay c. Language
c. Proactive interference d. Thinking
d. Retroactive interference 4. When a symbol stands for a class of objects or
17. Memory for a personal anecdote such as, “How I events with common properties, it refers to a:
lost the ring on the morning of my wedding day,” a. Language
would be stored in ____________ long-term b. Concept
memory. c. Emotion
a. Semantic d. Experiment
b. Episodic 5. Which cognitive process is characterized by the
c. Working use of symbols as representations of objects and
d. Implicit events?
18. _______ are organized bodies of information a. Perception
stored in memory that bias the way new b. Learning
information is interpreted, stored and recalled. c. Thinking
19. If, after learning a poem for a test a year ago, d. Memory
you now find yourself unable to recall what 6. Who among the following psychologists had
you learned, you are experiencing memory emphasized the cognitive approach in his
_________, caused by non-use. research on the development of understanding in
20. __________ interference occurs when material the child?
is difficult to retrieve because of exposure to a. EC Tolman
later material. ___________ interference refers b. Jean Piaget
to the difficulty in retrieving material due to the c. Sigmund Freud
interference of previous material. d. W Kohler
7. Thinking which aims at solving complex prob-
KEY lems is:
1. c 2. a 3. b 4. d a. Perceptual thinking
5. b 6. b 7. a 8. a b. Reflective thinking
9. a 10. b 11. c 12. c c. Abstract thinking
13. b 14. d 15. c 16. d d. Creative thinking
17. b 18. Schemas 19. Decay
8. You are asked the question, “How many windows
20. Retroactive, Proactive
are there in your parent’s house?” To answer, you
Thinking visualize the building and take a mental walk
1. Thinking is: around it, counting the windows. In achieving
a. Higher mental process the answer you use a(n):
b. Physical activity a. Mental image
c. Imagination b. Precursor to perception
d. None of the above c. Imaginary delusion
2. Thinking involves: d. Visual non-distractor
a. Id, ego, superego 9. Being able to generate unusual but appropriate
b. Receptors, connectors, effectors responses to problems or questions is called:
 Question Bank 207
a. The availability heuristic c. Reasoning
b. Divergent thinking d. Thinking
c. Cognitive complexity 17. Following is a method of problem solving in
d. Convergent thinking which one is presented with several alternatives
10. Higher type of thinking, quite careful, systematic among which one must choose:
and organized in functioning is termed as: a. Algorithms
a. Concrete thinking b. Heuristics
b. Perceptual thinking c. Decision making
c. Critical thinking d. Weighing alternatives
d. Thinking 18. Problem solving as a deliberate and serious act,
11. Divergent thinking involves: involves the use of:
a. Logical possibility a. Novel methods
b. Logical recognition b. Consideration of alternatives
c. Artistic thinking c. Higher thinking
d. Free association d. All of the above
12. A particular kind of set that can point thoughts in 19. ___________ are categorizations of objects that
the wrong direction is called: share common properties.
a. Functional solution 20. _________ is the term used to describe the sudden
b. Functional fixedness “flash” of revelation that often accompanies the
c. Fixedness solution to a problem.
d. Formal thinking 21. Thinking of an object only in terms of its typical
13. Reasoning is the stepwise thinking with: use is known as ___________.
a. Imaginations 22. A broader, related tendency for old problem-
b. Purpose or goal solving patterns to persist is known as a
c. Laws __________.
d. Both a and b
14. Which of the following is a cognitive activity KEY
that controls as well as affects the total behavior
1. a 2. b 3. c 4. b
and personality?
5. c 6. b 7. b 8. a
a. Concept formation 9. b 10. c 11. a 12. b
b. Reasoning 13. b 14. b 15. b 16. a
c. Problem solving 17. c 18. d 19. Concepts
d. Thinking 20. Insight 21. Functional fixedness
15. During which stage of creative thinking the 22. Mental set
thinker feels that he has no sight of the solution
Intelligence and Aptitude
to his problem?
a. Preparation 1. IQ stands for:
b. Incubation a. International quotient
c. Inspiration or illumination b. Intelligence quotient
d. Verification or revision c. Intelligent quotient
16. Awareness, understanding, collection of relevant d. None of the above
information, formulation of hypotheses, selection 2. The average IQ range is:
of proper solution, verification of solution are a. 90 – 110
steps of: b. 80 – 90
a. Problem solving c. 70 – 80
b. Creative thinking d. Below 70
208 Psychology for Nurses

3. When the mental age and chronological age is 9. The most common biological cause of mental
same, then IQ is: retardation is:
a. 95 a. Brain starvation of oxygen at birth
b. 98 b. Severe car accidents or other injuries
c. 110 c. Physical abuse during infancy
d. 100 d. Down syndrome
4. Intelligence not only helps in better career 10. Mental retardation is caused due to:
building, but also encourages in developing a. Physical hazards at birth
better relationship and better health in later life. b. Accidental head injury
c. Infection of the brain
This is called:
d. All of the above
a. Verbal intelligence
11. Spearman's (1927) g-factor of intelligence:
b. Performance intelligence
a. Is a hypothesized general factor of mental
c. Non-verbal intelligence ability that is measured by IQ tests
d. Emotional intelligence b. Represents an array of many independent
5. Intelligence is influenced by: factors that generate various mental abilities
a. Hereditary factors c. Is a quantitative measurement of the degree of
b. Environmental factors cultural bias present in IQ tests
c. Organic factors d. Is calculated as one's level of fluid intelligence
d. Both hereditary and environmental factors minus one's level of crystallized intelligence
6. When no language is used in an intelligence test 12. In which of the following stage creative thinker
it is called: turns away from the problem:
a. Performance test a. Preparation
b. Non-performance test b. Incubation
c. Verbal test c. Insight
d. Both a and b d. Verification
7. Which of these is a measure of intelligence that 13. Ability to handle words, numbers, formulae and
takes into account the individual's chronological scientific principles is _____________.
age and mental age? 14. ___________ tests predict a person's ability
in a specific area, while ____________ tests
a. Triarchic intelligence
determine the specific level of knowledge in an
b. Crystallized intelligence
area.
c. Deviation score
15. Some forms of retardation can have a genetic
d. Intelligence quotient basis and can be passed through families. True or
8. Mental retardation occurs when the person shows False?
a. Dependency on others for basic living needs 16. People with high intelligence are generally shy
such as shelter, food or protection and socially withdrawn. True or False ?
b. A preference to live in an institution for special 17. IQ tests can accurately determine the intelligence
needs of entire group of people. True or False?
c. Below average cognition with limitations in 18. Intelligence can be seen as a combination of
related skills __________ and __________ factors.
d. Abnormally excessive fantasizing or day- 19. Lower IQ test scores during late adulthood do not
dreaming to an extent that it interferes in daily necessarily mean a decrease in intelligence. True
social interactions with others or False?
 Question Bank 209

KEY c. Low in the need for affiliation

d. High in the need for solitude
1. b 2. a 3. d 4. d
6. A couple attends an anniversary party in hopes
5. d 6. a 7. d 8. c
9. d 10. d 11. b 12. b that the couple being honored will attend their
13. Abstract intelligence future party. This motivation is best understood
14. Aptitude, achievement by invoking the:
15. True a. Drive-reduction theory
16. False, the gifted are generally more socially adept b. Instinctive theory
than those with lower IQ. c. Incentive theory
17. False, IQ tests are used to measure individual
d. Cognitive theory
intelligence. Within any group there are wide
variations in individual intelligence
7. According to Maslow, which of the following is
18. Heredity, environmental the highest-order need?
19. True a. Esteem
b. Physiological
CHAPTER 4 c. Safety
MOTIVATION AND EMOTIONAL d. Belongingness
8. A person who works hard to increase his wealth
PROCESSES is satisfying his:
Motivation a. Social motives
1. The forces that govern the initiation and persis- b. Personal motives
tence of behavior are called: c. Biological motives
a. Emotions d. None of the above
b. Motives 9. Physical needs, security and safety, belonging­
c. Intellectual capacities ness, self-esteem, self realization are:
d. Personality attributes a. Needs of the learner
2. Primary drives are those which: b. Maslow's hierarchy
a. Are based on expectation c. Needs of teacher
b. Are biologically based d. None of the above
c. Are satisfied last 10. The hierarchy of needs according to Abraham
d. Are based on knowledge Maslow is:
3. Motives whose satisfaction is essential for life a. Physiological needs → safety needs → love
are called: needs → esteem needs → self-actualization
a. Primary motives b. Safety needs → physiological needs → esteem
b. Secondary motives needs → love needs → self-actualization
c. Accessory motives c. Self-actualization → esteem needs → physio­
d. All of the above logical needs → safety needs → love needs
4. An individual who is fighting to climb the career d. Physiological needs → self-actualization →
ladder is striving to satisfy his: safety needs → esteem needs → love needs
a. Primary motives 11. The concept of unconscious motivation is one of
b. Personal motives the cornerstones of:
c. Biological motives a. Social theory
d. Secondary motives b. Psychoanalytic theory
5. A person who joins a variety of social clubs and c. Incentive theory
has a wide variety of friends is likely to be: d. Humanistic school
a. High in the need for affiliation 12. The body's tendency to maintain a constant
b. Low in the need for achievement internal environment is called:
210 Psychology for Nurses

a. Thermostat KEY
b. Homeostasis
1. b 2. b 3. a 4. b
c. Need
5. a 6. c 7. a 8. b
d. Aggression 9. b 10. a 11. b 12. b
13. Which of the following theories of motivation 13. b 14. c 15. a 16. b
might be described as the 'push theories of 17. Motives 18. Instincts 19. Homeostasis
motivation'? 20. False, lower-order needs must be fulfilled before self-
a. Social learning theory actualization can occur
b. Drive theories 21. Achievement
c. Incentive theories
Emotional Processes
d. Opponent process theory
14. Opposition of one motive by the other motive 1. Emotions are different from feelings because:
results in a: a. They do not occur in normal people
a. Set b. They do no good for one's health
b. Habit c. They can cause physiological changes in the
c. Conflict body
d. Psychosis d. All of the above
15. A state that results when a motive is blocked can 2. The word emotion etymologically means:
be referred to as a: a. To stir up
a. Mental conflict b. To test
b. General tension c. To express
c. General stress d. To cry
d. None of the above 3. The general adaptation syndrome (GAS) was
16. An individual who is unable to choose between a described by:
job and higher education is experiencing: a. Hans Selye
a. A problem of adaptation b. Hull
b. A motivational conflict c. Gerald Caplan
c. A personality problem d. Carl Rogers
d. A negative emotion 4. The organ in the body, which triggers GAS is:
17. ________ are forces that guide a person's a. Anterior pituitary
behavior in a certain direction. b. Adrenal gland
18. Biologically determined, inborn patterns of c. Liver
behavior are known as ________. d. Hypothalamus
19. By drinking water after running a marathon, a 5. GAS is a response to:
runner tries to keep his or her body at an optimal a. Poor intelligence
level of functioning. This process is called b. Wrong perception
___________. c. Stress
20. According to Maslow, a person with no job, d. Poor nutrition
home and friends can become self-actualized. 6. The set of reactions occurring as a result of the
True or False ? first stage of GAS can be termed as:
21. Mr Ramu is the type of person who constantly a. Resistance reaction
strives for excellence. He feels intense satis-fac- b. Exhaustion reaction
tion when he is able to master a new task. Ramu c. Stress reaction
most likely has a high need for ___________. d. Fight-or-flight response
 Question Bank 211
7. Who among the following proposed that emotional 13. An example of displacement is:
states are a function of the interaction of cognitive a. Imaginative activity to escape reality
factors and a state of physiological arousal? b. Ignoring unpleasant aspects of reality
a. William James c. Resisting any demands made by other
b. S Schachter d. Pent up emotions directed to other than the
c. A Maslow primary source
d. Carl Rogers 14. Which of the following activities is aimed at
8. The stages of general adaptation syndrome pro- reducing anxiety:
gress in following stages: a. Aerobic exercises
a. Resistance → exhaustion → alarm b. Yoga
b. Alarm → exhaustion → resistance c. Meditation
c. Alarm → resistance → exhaustion d. All of the above
d. Exhaustion → alarm → resistance 15. The immediate bodily reaction to short-term
9. In the process of development the individual stress is likely to be:
strives to maintain, protect and enhance a. Aches and pains in diverse locations throughout
the integrity of the self. This is normally the body
accomplished through the use of: b. Arousal in the sympathetic autonomic nervous
a. Affective reactions system
b. Withdrawal patterns c. Denial; refusal to confront and accept the
c. Defence mechanism stressor's reality
d. Strong emotional forces d. Illness resulting from failure of the immune
10. A male college student who is smaller than system
average and unable to participate in sports 16. Disorders that occur due to severe stress are
becomes the life of the party and a stylish dresser. called __________________.
This is an example of the mechanism of: 17. __________ is a state of heightened susceptibility
a Rationalization to the suggestions of others.
b. Sublimation 18. ___________ is a learned technique for
c. Compensation refocusing attention to bring about an altered
d. Reaction formation state of consciousness.
11. After a horrible day at work, a father comes home 19. Emotions are always accompanied by a cognitive
and yells at his children for a minor mess. This is response. True or False ?
an example of: 20. The __________ theory of emotions states that
a. Repression emotions are a response to instinctive bodily
b. Rationalization events.
c. Projection 21. According to the ____________ theory
d. Displacement of emotions, both an emotional response
12. Sublimation is a defence mechanism that helps and physiological arousal are produced
the individual to: simultaneously by the same nerve stimulus.
a. Act out in reverse to something already done 22. What are the six primary emotions that can be
or thought identified from facial expressions ?
b. Return to an earlier, less mature stage of 23. ________ is defined as a response to challenging
development or threatening events.
c. Exclude from the conscious things that are
psychologically disturbing KEY
d. Channel unacceptable sexual desires into 1. c 2. a 3. a 4. d
socially approved behavior 5. c 6. d 7. b 8. c
212 Psychology for Nurses

9. c 10. c 11. d 12. d 7. Measurement of attitudes is carried out by:

13. d 14. d 15. a a. Opinion surveys
16. Psychophysiological disorders b. Self-report methods
17. Hypnosis c. Likert's method of summated ratings
18. Meditation
d. All of the above
19. False, emotions may occur without a cognitive
response 8. An intuitive attempt to infer the causes of
20. James-Lange behavior is:
21. Cannon-Bard a. Attitude
22. Surprise, sadness, happiness, anger, disgust and fear b. Attribution
23. Stress c. Will
d. Character
Attitude
9. What causes we have to consider to explain
1. A predisposition to respond in a certain way is: behavior?
a. Prejudice a. Situational causes
b. Attitude b. Dispositional causes
c. Bias c. Attitudes
d. Trait d. Both a and b
2. Attitudes are:
a. Innate KEY
b. Unlearned
c. Acquired 1. b 2. c 3. a 4. b
d. Learned 5. b 6. b 7. d 8. b
9. d
3. Components of attitude are:
a. Cognitive, affective, conative
CHAPTER 5
b. Id, ego, superego
c. Imagination, thinking and reasoning PERSONALITY
d. None of the above 1. Personality is unique for every individual because
4. Which of the following methods, like most other it is the result of the person's:
attitude measurement techniques, relies on the a. Intellectual capacity, race and socioeconomic
self-report of the respondents? status
a. Physiological measures b. Genetic background, placement in family and
b. Public opinion polling autoimmunity
c. Interview c. Biological constitution, psychological devel-
d. Case study opment and cultural setting
5. Which factors play an important role in develop- d. Childhood experiences, intellectual capacity
ment of attitudes? and socioeconomic status
a. Heredity 2. The relationship that is of extreme importance in
b. Environment the development of personality is that of the:
c. Health a. Peer
d. Illness b. Sibling
6. The procedure which measures the electrical c. Parent—child
resistance of the skin is: d. Heterosexual
a. EMG 3. For an emotional balance the individual always
b. GSR needs:
c. EEG a. Family work and play
d. ECG b. Financial security and social recognition
 Question Bank 213
c. Biologic satisfaction and social acceptance 11. The _________ pushes the person towards
d. Individual recognition and group acceptance greater virtue, while the __________ pushes the
4. The family is most important in the emotional person towards thoughtless pleasure-seeking.
development of an individual because it: a. Superego; id
a. Provides support for the young b. Id; ego
b. Gives rewards and punishment c. Superego; ego
c. Helps one to learn identity and roles d. Ego; id
d. Gives good educational background 12. During the oedipal stage of growth and develop-
5. Groups are important in the emotional develop- ment the child:
ment of the individual because peer group: a. Loves and hates both parents (ambivalence)
a. Always protects their members b. Loves parent of same sex and hates parents of
b. Are easily identified by their members opposite sex
c. Go through the same developmental phases c. Loves parent of opposite sex and hates parent
d. Identify acceptable behavior for their members of same sex
6. Problems with dependence versus independence d. Loves both parents
13. Resolution of the oedipal complex takes place
develop during the stage of growth and
when the child:
development known as:
a. Rejects parent of same sex
a. Infancy
b. Introjects behaviors of both parents
b. Toddler
c. Identifies with parent of the same sex
c. Preschool
d. Identifies with parent of the opposite sex
d. School age
14. An elderly client tells the nurse “I am useless to
7. The basic emotional task for the toddler is:
everyone, even myself”. The nurse recognizes
a. Trust that the client has probably failed to accomplish
b. Industry Erikson's developmental task of
c. Identification a. Identity vs Role diffusion
d. Independence b. Generativity vs Stagnation
8. _____________ originated psychoanalytic theory c. Ego integrity vs Despair
in the early 1900s. d. Autonomy vs Shame and doubt
a. Erik Erikson 15. The ability to tolerate frustration is an example of
b. Alfred Adler one of the functions of the:
c. Sigmund Freud a. Id
d. Carl Junk b. Ego
9. According to Freud, which component of c. Superego
personality operates according to the reality d. Unconscious
principle? 16. The superego is that part of the psyche, which:
a. Id a. Contains the instinctual drives
b. Ego b. Is the source of creative energy
c. Superego c. Operates on the pleasure principle and
d. Libido demands immediate gratification
10. Freud argued that exhibiting unusual rigidity or d. Develops from internalizing the concepts of
extreme disorderliness may be a sign of fixation parents and significant others
at the ____________ stage of personality. 17. Another term for superego is:
a. Oral a. Self
b. Anal b. Ideal self
c. Phallic c. Narcissism
d. Latency d. Conscience
214 Psychology for Nurses

18. A person has a mature personality, if the: a. Traits

a. Ego responds to the demands of the superego b. Quirks
b. Society sets demands to which the ego re- c. Factors
sponds d. Profiles
c. Superego controls the ego 26. According to the ___________ approach, the
d. Ego acts as a balance between the pressures of ultimate goal of personality growth is self-
the id and superego actualization.
19. Which of the following represents the proper a. Neo-Freudian
order of personality development according to b. Psychoanalytic
Freud? c. Psychosocial
a. Oral, phallic, latency, anal, genital d. Humanistic
b. Anal, oral, phallic, latency, genital 27. The tests of personality that best reflect the
c. Oral, anal, phallic, latency, genital unconscious are:
d. Anal, oral, phallic, genital, latency a. Self-administered questionnaires
20. Ego theory of personality was proposed by: b. Rating scales and checklists
a. BF Skinner c. Projective techniques
b. Abraham Maslow d. Observation for prolonged periods
c. Erik Erikson 28. Classification into endomorphic, mesomorphic
d. Sigmund Freud and ectomorphic was proposed by:
21. Which approach to personality emphasizes the a. Hippocrates
innate goodness of people and their desire to b. Ernst Kretschmer
grow? c. Sheldon
a. Humanistic d. Jung
b. Psychoanalytic 29. Classification into introvert and extrovert types
c. Learning was proposed by:
d. Biological a. Hippocrates
22. Personality has been described in terms of traits b. Ernst Kretschmer
by: c. Sheldon
a. Cattell d. Jung
b. GW Allport 30. What is an ambiguous stimuli in a Rorschach
c. Maslow test?
d. Karn Horney a. Visual illusions
23. Which stage of Erikson's psychosocial develop- b. Stories without endings
ment theory deals with adolescence? c. Inkblots
a. Ego-integrity vs Despair d. Slightly blurred pictures
b. Generativity vs Stagnation 31. Which of the following is a similarity between
c. Intimacy vs Isolation the Rorschach test and the thematic apper-
d. Identity vs Role confusion ception test (TAT)?
24. The later childhood stage of Erikson's psychoso- a. Both tests are examples of projective personal-
cial development theory is: ity tests
a. Autonomy vs Shame and doubt b. Both tests are examples of the learning ap-
b. Industry vs Inferiority proach to studying personality
c. Initiative vs Guilt c. Both tests have evolved from and are similar to
d. Trust vs Mistrust the MMPI
25. __________ are enduring dimensions of d. Both tests are biological in nature
personality characteristics along which people 32. Being impatient, irritable, always in a hurry and
differ. working under deadlines are traits associated with:
 Question Bank 215
a. Oral stage fixation c. Both a and b
b. Latency stage fixation d. Changes in height and weight
c. Type A personality 3. Puberty:
d. Type B personality a. Typically begins earlier in boys than in girls
33. Sixteen personality factor questionnaire was b. Typically begins later in girls living in affluent
developed by __________. homes
34. Expand TAT. c. Is the period at which maturation of the sexual
35. Which type of personality people are more prone organs occurs
to get coronary artery disease ? d. Is a consequence of heredity and not affected
36. Expand MMPI. by culture or class
37. Erikson's theory of __________ development 4. Which of the following is continuous?
involves a series of eight stages, each of which a. Growth
must be resolved in order for a person to develop b. Development
optimally. c. Both growth and development
38. A person shown a picture and asked to make up d. None of the above
a story about it would be taking a ___________ 5. Which of following factor/factors influence for
personality test. growth and development?
39. __________ therapies assume people should a. Heredity
take responsibility for their lives and the decision b. Cultural factors
they make. c. Environmental factors
d. All of the above
KEY 6. Which of the biological factors influence physical
1. c 2. c 3. d 4. c growth?
5. d 6. b 7. d 8. c a. Family economic status
9. b 10. b 11. d 12. c b. Intelligence
13. c 14. c 15. b 16. d c. Endocrine glands
17. d 18. d 19. c 20. c d. Both b and c
21. a 22. b 23. d 24. b 7. Growth and development in any one dimension
25. a 26. d 27. c 28. b
affects the growth and development in other
29. d 30. c 31. a 32. c
33. Raymond Cattell dimensions too, that is:
34. Thematic Apperception Test a. Principle of integration
35. Type A b. Principle of uniformity
36. Minnesota Multiphasic Personality Inventory c. Principle of interaction
37. Psychosocial d. Principle of interrelation
38. Projective 39. Humanistic 8. Which stage of the life is characterized by rapid
growth and development?
CHAPTER 6 a. Infancy
DEVELOPMENTAL PSYCHOLOGY b. Toddler
1. Growth implies: c. Preschooler
a. Physical changes in the individual d. Adolescent
b. Quantitative changes in the individual 9. Which of the following is a psychological need
c. Changes in structure for the infant?
d. All of the above a. Love
2. Development refers to: b. Education
a. Qualitative change c. Encouragement
b. Quantitative change d. Provision for self-expression
216 Psychology for Nurses

10. Neonatal period refers to: CHAPTER 7

a. First 4 weeks after birth MENTAL HYGIENE AND MENTAL
b. First 12 months after birth
c. First 1 week after birth
HEALTH
d. First 2 weeks after birth 1. Mental hygiene is:
11. Which of the following is the infant's main a. A general set of principles that promote a
method of communication? healthy personality
a. Body movement b. A general set of principles that promote a
b. Crying healthy learning
c. Smiling c. A general set of principles that promote
d. Restless movements positive emotions
12. Which of the following nursing intervention is d. A general set of principles that promote good
more appropriate for an infant? intellectual capacity
a. Personal attention such as handling, cuddling, 2. Which of the following is the predisposing factor
holding for mental illness?
b. Providing physical security a. Genetic make up
c. Praising the child for his cooperation b. Brain damage
d. Providing privacy c. Psychological stress
13. Which of the following nursing intervention is d. All of the above
more appropriate for an adolescent? 3. Basics for a child’s good mental health include:
a. Personal attention such as handling, cuddling, a. Unconditional love
holding b. Minor illness
b. Providing physical security c. Immunization
c. Explaining each procedure with scientific d. Weaning
rationale 4. One of the characteristics of a mentally healthy
d. Using sensory soothing measures individual is:
14. Elisabeth Kubler-Ross observed that people a. Ability to make adjustments
facing death move through five stages in the b. Ability to control anger
following order: c. Ability to be courageous
a. Denial, anger, bargaining, depression, acceptance d. Genuine concern towards others
b. Denial, depression, anger, bargaining, acceptance 5. Which of the following is a sign of poor mental
c. Anger, bargaining, denial, depression, acceptance health during adolescent period?
d. Bargaining, anger, denial, acceptance, depression a. Frequent temper tantrums
15. Adolescent period starts from onset of puberty b. Hyperactivity
and ends with attainment of maturity. True/False? c. Abuse of drugs or alcohol
16. Development of habits, attitudes, manners are d. Poor grades in school
called moral development. True/False? 6. The aim of primary prevention is:
17. Developmental psychologists are interest- a. Decreasing the duration of disorder
ed in the effects of both ____________and b. Reducing the incidence of mental illness
______________ on development. c. Reducing the impairment of mental illness
d. Reducing complications of mental illness
KEY 7. __________ described levels of prevention
specific to psychiatry.
1. d 2. a 3. c 4. b
5. d 6. c 7. d 8. a
9. a 10. a 11. b 12. a
KEY
13. c 14. a 15. True 16. True 1. a 2. d 3. a 4. a
17. Heredity, environment 5. c 6. b 7. Gerald Caplan
 Question Bank 217
Personal and Social Adjustment 2. The following are the principles of counseling
except:
1. Following are the characteristics of a well-
a. Accurate understanding of the patient
adjusted person, except:
b. Superiority feeling towards patient
a. Respects self and others
c. Demonstration of concern towards patient
b. Fault finding attitude
d. Avoid making biased judgment
c. Ability to deal with adverse circumstances
3. The following are the principles of guidance
d. Aware of one’s own strengths and weaknesses
program except:
2. Which of the following is an indirect method of
a. It should be flexible
adjustment?
b. It should be based on individual needs
a. Increasing trails
c. It should be based on counselor’s needs
b. Improving efforts d. It is a continuous process
c. Compromising
4. Who should be counseled?
d. Withdrawal a. Students who have a consistent record of under
3. Which of following is a characteristic feature of achievement
a maladjusted person? b. Students whose scholastic achievement drops
a. Extreme daydreaming suddenly
b. Respects self and others c. Students who have difficulty adjusting to the
c. Realistic perception of the world college
d. Ability to cooperate with others d. All of the above
4. Which of the following factor contributes to 5. In which of the following counseling one-to-one
maladjustment during childhood? helping relationship between the counselor and
a. Age at maturity counseled will occur?
b. Low socioeconomic status a. Group counseling
c. Sex inappropriateness b. Individual counseling
d. Unrealistic levels of aspiration c. Directive group counseling
5. Which of the following factor contributes to d. Non-directive group counseling
maladjustment during old age? 6. Which of the following is the first step in coun-
a. Chronic illness seling?
b. Unrealistic levels of aspiration a. Developing insight into the problem
c. Suppression of creativity b. Collecting data from client
d. Sex inappropriateness c. Establishing rapport with the client
d. Encourage the client to ventilate his problems
KEY 7. Following are the skills required for a counselor
except:
1. b 2. d 3. a 4. b a. Good psychological health
5. a
b. Approachability
Guidance and Counseling c. Open-mindedness
d. Fixed ideas on problem
1. What is guidance?
8. Which of the following guidance is concerned
a. It helps the individual to manage his own life with enabling students to acquire information
activities about career opportunities, career growth and
b. It helps the individual to solve his medical training facilities?
problems a. Personal guidance
c. It helps the individual to control disability b. Social guidance
d. It helps the individual to solve his financial c. Educational guidance
problems d. Vocational guidance
218 Psychology for Nurses

9. Which of the following guidance is concerned c. Intelligence tests

with enabling students to adjust to the situation d. Occupational tests
which they cannot change? 5. Standard measure devices that assess behavior
a. Personal guidance objectively are called:
b. Social guidance a. Factor analysis procedures
c. Educational guidance b. Psychological tests
d. Vocational guidance c. Temperament assessment scales
10. What is the function of financial guidance ? d. Behavioral assessment tests
a. It helps the student in determining the financial 6. ________________ is the consistency of a
assistance personality test, while _________ is the ability
b. It helps the student to control financial needs of a test to actually measure what it is designed
c. It provides financial support to measure.
d. None of the above 7. ___________ are the standards used to compare
scores of different people taking the same test.
KEY
KEY
1. a 2. b 3. c 4. d
5. b 6. c 7. d 8. d 1. b 2. a 3. d 4. b
9. a 10. a 5. b 6. Reliability, validity
7. Norms

CHAPTER 8 CHAPTER 9
PSYCHOLOGICAL ASSESSMENT INDIVIDUAL DIFFERENCES
AND TESTS 1. Individual differences means:
1. The following are the characteristics of psycho- a. Individuals differ from each other
logical tests except: b. Differences that separate one person from
a. Standardization another
b. Appropriateness c. Differences that totally distinguish one indi-
c. Reliability vidual from another
d. Validity d. All of the above
2. Which of the following is the first step in 2. Which of the following is a physical difference
development of psychological tests? among individuals?
a. Analysis of situation a. Facial expression
b. Selection of test items b. Emotional expression
c. Administration of test c. Attitudinal expression
d. Evaluation of test d. Moral expression
3. Which of the following test is designed to be 3. Which of the following is an important factor in
administered to one person at a time? determining individual differences?
a. Group test a. Family
b. Power test b. Culture
c. Paper-pencil test c. Heredity
d. Individual test d. Socioeconomic status
4. Specific abilities are measured by:
a. Achievement tests KEY
b. Aptitude tests 1. a 2. a 3. c
Bibliography

1. Anthikad Jacob. Psychology for Graduate 11. Matlin W Margaret. Psychology 3rd edition
Nurses 4th edition, New Delhi: Jaypee Brothers, Harcourt Brace College Publishers: Philadelphia,
2007. 1999.
2. Bhatia BD, Craig Margaretta. Elements of 12. Morgan T Cifford, Kind A Richard, Weisz R
Psychology and Mental Hygiene for Nurses in John, et al. Introduction to Psychology 7th
India. Orient Longman: Chennai, 2005. edition. Tata McGraw-Hill Publishing Company
3. Das G. Educational Psychology New Delhi: Limited: New Delhi, 2004.
Kind Books 13. Myers G David. Social Psychology, 6th edition,
4. Gross Richard, Kinnison Nancy. Psychology for McGraw-Hill College: Boston, 1991.
Nurses and Allied Health Professionals London: 14. Nagaraja KR, Begum Shamshad B, Sudarshan
Hodder Arnold, 2007. CY. MCQs in Psychology for Nursing and Allied
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Introduction to Psychology 6th edition, Oxford Pvt Ltd:New Delhi, 2006.
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and IBH publishing Co Pvt Ltd: New Delhi,
Hygiene for Nurses. Kedarnath Ram Nath and
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6. Hurlock B Elizabeth. Developmental Psychology
16. Robert S Feldman. Understanding Psychology
a Lifespan Approach, 5th edition, Tata McGraw-
6th edition, Tata McGraw-Hill Edition: New
Hill Edition: New Delhi, 2002. Delhi, 2004.
7. Khan MA. Psychology for Nurses. Academa 17. Sinclair C Helen, Fawcett N Josephine. Altschul’s
Publishers: Delhi, 2004. Psychology for Nurses 7th edition, Bailliere
8. Kuppuswamy B. An Introduction to Social Tindall: London, 1991.
Psychology. Media Promoters and Publishers Pvt 18. Skinner E Charles. Educational Psychology
Ltd: Bombay, 1994. 4th edition Prentice-Hall of India Pvt Ltd: New
9. Mangal SK. Advanced Educational Psychology Delhi, 1996.
6th edition, Prentice Hall of India Pvt Ltd: New 19. Taylor E Shelley. Health Psychology 6th edition,
Delhi, 2007. Tata McGraw-Hill Edition: New York, 2006.
10. Mangal SK. General Psychology. Sterling 20. Zwemer J Ann. Basic Psychology for Nurses in
Publishers Pvt Ltd: New Delhi, 2006. India. BI Publications Pvt Ltd: Chennai, 2003.
Index

Page numbers followed by f refer to figure and t refer to table

A Arousal theory of motivation 98, 98f

Acetylcholine 23 Assessment of intelligence 79
Achievement Association cortex 25
motive 183 Attention 30, 116, 184
test 176, 183 Attitude 184
Acquired immunodeficiency syndrome 124, 172 learning 38
Acronym 61 scales 120
Act of fixation of mind 32 Authenticity 170
Adrenal glands 21 Autocratic leadership 184
Adrenocorticotropin hormone 114, 115f Autonomic nervous system 108
Aggression 101 Autonomy 159
Agnosia 84
Alarm reaction 113, 114f, 183 B
Albert Bandura exponent of social learning theory 50f
Balanced development of personality 159
Allport’s classification 127, 128f, 128t
Bandura and Walter’s social learning theory 138
Alterations in
Basic potential of learner 40
attention 33, 83
cognitive processes 83 Behavior 184
emotions during illness 120 and attitude 118
intelligence 85 modification 184
learning 83 Biological environment 17
memory 84 Biology of behavior 14
perception 83 Blood pressure 104
personality 141, 142 Bloom’s taxonomy 68
Alzheimer’s disease 84 Bodily movement and gestures 105
Amnesia 84, 85, 183 Body
Anal stage 183 image 153
Analysis of mind relationship 14
results 11 Brain 36
situation 177 and behavior 18
Antisocial personality disorder 183 functions 69
Anxiety 121, 184 structures 108
Apperception theory of transfer 53 Branches of
Applications applied psychology 6
in nursing profession 86 psychology 4f
of psychology 7, 7f pure psychology 5
Aptitude 76, 184 Bronchial asthma 109
test 81, 176 Bruner’s theory 76
222 Psychology for Nurses

C Controlled thinking 65
Cannon-Bard theory 107, 107f, 184 Convergent thinking 185
Catharsis 184 Coping styles according to Roger and Nash 115
Causes of forgetting 63 Corticotropin releasing hormone 113, 115f
Central nervous system 23, 184 Counseling of families 174
Cerebellum 184 Counselor centered counseling 172
Cerebral cortex 184 Creative thinking 65
Cerebrum 24, 184 Crisis intervention 162, 173
Characteristics of Critical thinking 65
frustration 101 Crystallized intelligence 186
mentally healthy person 159 Curriculum planning 124
psychological tests 177
well-adjusted person 168 D
Chromosomes 184 Declarative memory 186
Chronic constipation 109 Defective functioning of sense organs 36
Classification of Definitions of psychology 3
coping strategies according to Cohen and Lazarus 115 Delirium 85
groups 156 Dementia 84, 85
intelligence 74 Depression 153
tests 79f Determinants of attention 30
personality disorders 143 Development of
psychological tests 176 psychological tests 177
long-term memory 57f standardized procedures 177
Clerical aptitude 78 Developmental
Cognitive method 12
behavioral approach 185 psychology 6, 146, 186
processes 30 Diabetes and tuberculosis 109
psychology 185 Differential aptitude test 177
social learning theory 185 Direct
theory of learning 50 aggression 101
thinking errors 70 methods 164
Collection of relevant information 66 Discontinuous distraction 33
Collective unconscious 185 Disorders of written expression 84
Community psychology 185
Displaced aggression 101
Components of emotion 103, 104f
Dissociative amnesia 186
Computer-assisted tests 176
Divergent thinking 186
Concepts of
Division of attention 33
mental
Dollard and Miller’s learning theory of personality 137
health 159
Dopamine 23
hygiene 158
Double approach-avoidance conflict 186
motivation 94
Down syndrome 186
stress 109
Drive theories 97, 186
Concrete intelligence 74
Conditioned stimulus 45, 185 Duct glands 21
Conformity 185 Duration of attention 32
Conscious experience 104 Dynamics of personality 131
Consciousness 185
E
Consultation services 162
Continuous Eclectic counseling 172
distraction 33 Educational
reinforcement schedule 47, 185 guidance 169
 Index 223
implications of associated with
classical conditioning theory 45 learner 40
operant conditioning theory 47 men and material 41
theory of insightful learning 49 type of learning experience 40
Thorndike theory 43 influencing
transfer of learning 54 learning 39
psychology 6 memory 57
Effects of transfer of learning 52
bodily conditions on mental functioning 14 theories of intelligence 75
mental conditions on bodily functioning 15 Fantasy 101
stress 111, 112f Final selection of test items 177
Ego 186 Financial guidance 170
defence mechanisms 164, 165 Fixed
Electrocardiogram 120 interval
Electrocardiography 120 reinforcement schedule 47
Electroencephalogram 120 schedule 187
Emotion 32, 187 ratio
focused coping 114 reinforcement schedule 47
in health and illness 108 schedule 187
Emotional Fluid intelligence 187
expression 104 Force of habit 96
intelligence 74, 187 Forebrain 24
Endocrine gland 21, 187 Forgetting 62, 188
Endorphins 23
Formulation of hypothesis 11, 66
Environmental mastery 159
Founder of
Epilepsy 109
psychoanalytic theory 130f
Episodic memory 187
psychosocial theory 133f
Erikson’s eight stages of psychosocial development 133f,
Fraternal twins 188
134t
Freud’s
Evaluation of final test 177
components of personality 130f
Evolution of meaning of psychology 1f
stages of personality development 131f, 132t, 133
Evolutionary psychology 187
structure of personality 131f
Experimental
group 187 Frustration 100, 188
manipulation 187 Functional
method 10, 11 colitis 109
psychology 6 fixedness 188
Explicit Functioning of personality components 130f
memory 187 Functions of neurotransmitters 23t
volitional attention 30
Extinction 45, 187 G
Extrasensory perception 187 Galvanic skin response 120, 188
Extrinsic motivation 187 Gamma aminobutyric acid 23
Eysenck’s trait-type theory of personality 137t Gardner’s
eight major kinds of intelligence 74t, 75f
F multiple intelligence 74
Facial expressions 105 Gastric glands 21
Factors General
affecting adaptation syndrome 113, 188
attitudinal change 119 aptitude test battery 177
perception 35 Genes 188
224 Psychology for Nurses

Genital stage 188 Individual

Geopsychology 6 centered intervention 160
Gestalt counseling 171
laws of organization 188 performance tests 79
psychology 2, 48, 188 verbal tests 79
therapy 188 Industrial organizational psychology 189
Glands 21 Infancy 146, 189
Glutamate 23 Infertility 153
Gordon Allport’s theory 136 Information processing theory 59, 59f, 76
Group Insomnia 109
counseling 171 Instinct theory of motivation 97
non-verbal intelligence tests 79 Integrative function of nervous system 28
therapy 157, 188 Integrity 189
verbal intelligence tests 79 Intellectualization 189
Growth hormone-releasing hormone 113, 115f Intelligence 73, 189
Guidance and counseling in quotient 75, 189
hospital 173 tests 177, 189
nursing education 174 Intensity of stimulus 31
Guidelines for successful counseling 172 Intercellular environment 17
Interest tests 177
H Interference
Hallucination 36 of association 63
Handling theory 63, 64f
emotions 121 of forgetting 189
parent’s anxiety 148 Internal
Hans Eysenck’s theory 137 conflicts 103
Health receptors 19
guidance 170 Interpersonal counseling 172
psychology 188 Interpretation of psychological tests 179
Heart disease 109, 128 Interview method 138
Hippocrates classification 126 Intrauterine environment 17
of personality 127t Intrinsic motivation 190
Homeostasis 93, 188 Introspection 9, 190
Horizontal vertical illusion 83 Isolation of stimulus 31
Hormone 108, 188
Human growth hormone 114, 115f J
Hunger motive 94 James-Lange theory 106, 106f, 190
Hyperthymestic syndrome 84 Jung’s
Hypnosis 189 classification 127
Hypothalamus 24 of personality 128t
two basic types of personality 128f
I
Id 189 K
Illusion of length 83 Kidneys 21
Immediate memory 56 Kohler’s chimpanzee 49f, 50f
Implicit Kretschmer’s classification 127
memory 189 of personality 127t
volitional attention 30
Inadequate stimulus 36 L
Incentive theory of motivation 98 Lacrimal glands 21
Indirect methods 165 Laissez-Faire leadership 190
 Index 225
Latency period 190 Mathematics disorders 84
Latent learning 190 Meaning of
Law of behavior 1
association 42 individual differences 180
disuse 41 Meaningfulness of material 41
effect 41 Measurement of aptitude 81, 120
exercise/use 41 Mechanism of heredity 15
frequency 41 Medulla 190
learning 41 Memory 55, 190
primacy 41 images of past experience 36
purpose 42 peg system 61
readiness 41 trace 190
Lazarus theory 107, 108f Mental
Leading happy and contented life 159 health 158
Learner’s agencies 163
mental health 40 education 161
physical health 40 services 163, 164
Learning 37, 190 hygiene 158
process 51 and mental health 158
theories retardation 191
approach 190 Methodology of learning 40
of personality 137 Methods of
Left and right brains 26f arousing attention 30
Legal psychology 6 Methods of loci 62
Levels of Methods of memorizing 60
aspiration 96 Methods of psychology 9, 9f
motivation 40 Midbrain 25, 191
processing theory 59, 60f Military psychology 6
Levels of thinking 68 Minnesota multiphasic personality inventory 177, 191
Libido 190 Morbid forgetting 62
Limbic system 24, 190 Motivational cycle 98f, 191
Limitations of Motives 31, 94
intelligence tests 81 Motor
psychological tests 179 learning 38
Lobes of brain 25t, 26f neurons 22, 191
Localization of mental functions in brain 27f Movement of stimulus 31
Location of Muller-Lyer illusion 83
major endocrine glands 21f Muscles 20
stimulus 31 Myelin sheath 191
Long-term memory 56, 190
N
M Natural forgetting 62
Major Naturalistic observation 191
landmarks in development of psychology 3t Nature of
perspectives of psychology 2t attitude 116
structures in brain 27f behavior of organism 28
subfields of psychology 5t learning 37
Maladaptive coping styles 116t experience 40
Male sex glands 21 memory 56
Marriage guidance counseling 173 stimulus 31
Maslow’s hierarchy of needs 98, 135 Neo-Freudian psychoanalysts 191
226 Psychology for Nurses

Nerve fiber 191 Personal motives 96

Nervous system 18, 23, 192 Personality 192
Neural development 135
impulse 22 disorder 192
stimulus 192 inventories 120, 139, 192
Neuron 22 tests 128, 177
Neuropsychological tests 177 Phases of counseling 171
Neurotransmitters 23, 192 Phobias 192
Neutral stimulus 45 Physical environment 17
Non-governmental organizations 163 Physiological psychology 6
Non-judgmental attitude 170 Piaget’s four stages of cognitive development 72f, 73t
Non-possessive warmth 170 Pituitary gland 21, 193
Nursing implications of Political psychology 7
aptitude 88 Positive
attention 86 reinforcer 46, 193
attitude 123 transfer 52, 193
emotions 122 Preconscious 193
individual differences 182 Principle of
intelligence 88 adaptability 35
learning 86 closure 34, 34f
memory 87 context 35
motives 122 contour 35
perception 86 contrast 35, 35f
sensory process 20 counseling 170
thinking 87 figure-ground relationship 34
Nursing interventions for grouping 34, 35f
emotional reactions 121 guidance 169
impaired memory 87 perception 34
psychological tests 178
O simplicity 35
Observation method 139 Proactive interference 193
Observational Problem
learning 50, 192 awareness 66
method 10 focused coping 114
Occupational tests 177 solving
Older children and adolescents 160 counseling 173
Operant conditioning 192 learning 38
Opinion surveys 120 Projective
personality test 193
P techniques 119, 139
Proximity 193
Paired-associate learning 39 Psychoanalysis 2
Pancreas 21 Psychoanalytic theory 130, 193
Paper-pencil and performance tests 176 Psychological assessment and tests 176
Parapsychology 6 Psychology of
Parasympathetic system 192 caregivers during illness 154
Parathyroid gland 21 challenged individuals 152
Parts of nervous system 24f groups 155
Peptic ulcer 109 sensations 19
Perceptual organization 34 sick person 154
Peripheral nervous system 27, 192 vulnerable individuals 152
 Index 227
Psychometric assessment of Schedules of reinforcement 46, 194
attitudes 120 Scientific method 194
cognitive process 78 Scope of psychology 4
emotions 120 Self-observation method 9
motivation 119 Self-report methods 120
personality 138 Semantic memory 194
Psychosocial Sensation 19, 195
development 193 Sense organs 19, 35
environment 17 Sensory
Psychosomatic illness 193 experience 19, 20f
Psychotherapy 193 memory 56, 195
Public opinion polling 120 neurons 22
Pull theory of motivation 98 Sentence completion test 140
Purposes of guidance and counseling 173 Serotonin 23
Push theory of motivation 97 Sex
glands 21
R motive 95
Rape 153 Shaping 195
Rationalization 193 Sheldon’s classification 127
Raymond Cattell’s theory 136 of personality 127t
Reading disorders 84 Shifting attention 32
Red blood cells 113 Short-term memory 56, 195
Reduced optimum health 110 Similarity of content 53
Reflective thinking 65 Situational tests 120, 140
Reflex 194 Size of stimulus 31
Regression 102, 194 Skill 195
Reinforcement 46, 194 Skinner box 46
Repetition of stimulus 31 Social
Repression 194 adjustment 168
theory 64 guidance 170
Resistance reaction 113 intelligence 74
Resolution of frustration and conflict 103 learning theory 138f
Respiratory motive 95 motives 195
Retention 194 psychology 5, 195
Reticular activating system 25, 194 Society centered preventive measures 161
Retrograde amnesia 194 Somatoform disorder 195
Right and left hemispheres 25 Source of
Rogers person-centered approach 135 distraction 33
Role of nurse 146-151 frustration 101
in primary prevention 160 Space and unspaced method 60
in psychological assessment 179 Span of
in secondary prevention 161 attention 32
in tertiary prevention 162 auditory attention 32
Rorschach visual attention 32
inkblot test 140 Spinal cord 27
test 140f, 194 Spontaneous recovery 45, 195
Stages
S in development of thinking 71
Salivary glands 21 of creative thinking 67
Schachter-Singer theory 107, 194 of memory 59f
228 Psychology for Nurses

Steps in Trace decay theory 63

experimentation 11 Training of health personnel 162
learning process 51 Trait
observation method 10 theory 196
Stereotype 102, 195 type theory of personality 137
Stimulus 195 Transactional analysis 196
discrimination 195 Transfer of learning 52
generalization 45, 195 Transposition theory of transfer 53
Stress 109, 195 Trial and error theory of learning 42
cycle 110, 110f Types of
Stressor 109, 110 attention 30
Strong motivation 70 conflict 102
Structure of neuron 22f coping strategies 115f
Study habits 55 counseling 171
Studying for examination 55 defence mechanisms 167, 167t
Summary of various theories of learning 50 distraction 33
Superego 195 environment 17
Suppression 195 forgetting 62
Survey method 12 illusions 83
Sustained attention 32 individual differences 180
Sweat glands 21 learning 39, 39f
memory 56
T motives 94
Teen pregnancy 153 perceptual learning 38f
Temporal lobes 196 personality 126
Tentative selection of test items 177 psychological
Tertiary prevention 162 differences 180
Test norms 177 tests 176
Thalamus 196 reinforcement and punishment 47t
Thematic apperception test 119, 140, 196 thinking 65
Theoretical model of Schachter-Singer theory 107f transfer 52
Theories of
emotion 105, 106t U
forgetting 63 Unconditioned stimulus 45, 196
general memory functions 58 Uses of
generalization 53 intelligence tests 79
insightful learning 48 psychological tests 178
intelligence 75
learning 42 V
memory 58 Variable
motivation 96 interval schedule 196
personality development 128 ratio
psychosocial development 133 reinforcement schedule 47
transfer of learning 53 schedule 197
Three stage model of Various steps of experimental method 11f
general adaptation syndrome 113f Verbal
memory 56f learning 38
Thyroid gland 21, 196 reasoning 81
Thyrotropin-releasing hormone 113, 115f Visual acuity 197
Topography of personality 126 Voice disturbances 105
 Index 229
Voluntary Word association test 140
attention 30 Working memory 197
behavioral methods 120 Wundt’s approach 195
W
Z
Warning signs of poor mental health 160
Wernicke-Korsakoff syndrome 84 Zero transfer 52
Wolfgang Kohler chief exponent of theory of learning 48f Zygote 197