Reflect on your overall practicum experience in this course- ( PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM). Then, address the following in your Practicum Journal:

Explain whether your therapeutic theory has changed as a result of your practicum experiences. Recall the theories you selected in Week 1.
Explain how you integrated the therapeutic approaches from this course in your clinical practice. Include how this helped you achieve the goals and objectives you developed in Week 1.
Explain how you might impact social change through your work with clients who have mental health issues.
Support your approach with evidence-based literature.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

Need Theory

The Nursing Need Theory was developed by Virginia Henderson and was derived from her practice and education. Henderson's goal was not to develop a theory of nursing, but rather to define the unique focus of nursing practice. The theory emphasizes the importance of increasing the patient's independence so that progress after hospitalization would not be delayed.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.. Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the patient and how nursing can assist in meeting those needs.


Henderson identifies three major assumptions in her model of nursing. The first is that "nurses care for a patient until a patient can care for him or herself," though it is not stated explicitly. The second assumption states that nurses are willing to serve and that "nurses will devote themselves to the patient day and night." Finally, the third assumption is that nurses should be educated at the college level in both sciences and arts.

The four major concepts addressed in the theory are the individual, the environment, health, and nursing.

According to Henderson, individuals have basic needs that are components of health. They may require assistance to achieve health and independence, or assistance to achieve a peaceful death. For the individual, mind and body are inseparable and interrelated, and the individual considers the biological, psychological, sociological, and spiritual components. This theory presents the patient as a sum of parts with biophysical needs rather than as a type of client or consumer.

The environment is made up of settings in which an individual learns unique patterns for living. All external conditions and influences that affect life and development. The environment also includes individuals in relation to families.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.. The theory minimally discusses the impact of the community on the individual and family. Basic nursing care involves providing conditions in which the patient can independently perform the fourteen components explained in the model.

There are fourteen components based on human needs that make up nursing activities. These components are:

  1. Breathe normally. Eat and drink adequately.
  2. Eliminate body wastes.
  3. Move and maintain desirable postures.
  4. Sleep and rest.
  5. Select suitable clothing. That is, dress and undress appropriately.
  6. Maintain body temperature within normal range by adjusting clothing and modifying the environment.
  7. Keep the body clean and well groomed and protect the integument.
  8. Avoid dangers in the environment and avoid injuring others.
  9. Communicate with others in expressing emotions, needs, fears, or opinions.
  10. Worship according to one's faith.
  11. Work in such a way that there is a sense of accomplishment.
  12. Play or participate in various forms of recreation.
  13. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

These components show a holistic approach to nursing that cover the physiological, psychological, spiritual, and social. The first nine components are physiological. The tenth and fourteenth are psychological. The eleventh component is spiritual and moral. The twelfth and thirteenth components are sociological, specifically addressing occupation and recreation.

The theory's definition of health is based on an individual's ability to function independently as outlined in the fourteen components. Nurses need to stress the promotion of health and prevention, as well as the curing of diseases. According to Henderson's model, good health is a challenge because it is affected by so many different factors, such as age, cultural background, emotional balance, and others. PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

Henderson's definition of nursing states: "I say that the nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible." The nurse is expected to carry out a physician's therapeutic plan, but individualized care is result of the nurse's creativity in planning for care. The nurse should be an independent practitioner able to make independent judgments as long as he or she is not diagnosing, prescribing treatment, or making a prognosis, since those activities are the function of the physician. PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

Henderson explains in Nature of Nursing that the role of a nurse is "to get inside the patient's skin and supplement his strength will or knowledge according to his needs." The nurse has the responsibility to assess the needs of the patient, help him or her meet health needs, and provide an environment in which the patient can perform activity unaided.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

Goal Attainment

The Theory of Goal Attainment was developed by Imogene King in the early 1960s. It describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. The theory explains that factors which can affect the attainment of goals are roles, stress, space, and time.

The model has three interacting systems: personal, interpersonal, and social. Each of these systems has its own set of concepts. The concepts for the personal system are perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are interaction, communication, transaction, role, and stress. The concepts for the social system are organization, authority, power, status, and decision-making.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

The following propositions are made in the Theory of Goal Attainment:

  • If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur.
  • If the nurse and patient make transaction, the goal or goals will be achieved.
  • If the goal or goals are achieved, satisfaction will occur.
  • If transactions are made in nurse-patient interactions, growth and development will be enhanced.
  • If role expectations and role performance as perceived by the nurse and patient are congruent, transaction will occur.
  • If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur.
  • If a nurse with special knowledge communicates appropriate information to the patient, mutual goal-setting and goal achievement will occur.

There are also assumptions made in the model. They are:

  • The focus of nursing is the care of the human being (patient).
  • The goal of nursing is the health care of both individuals and groups.
  • Human beings are open systems interacting with their environments constantly.
  • The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption of the nursing process.
  • Patients perceive the world as a complete person making transactions with individuals and things in the environment.
  • Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences.

According to King, a human being refers to a social being who is rational and sentient. He or she has the ability to perceive, think, feel, choose, set goals, select means to achieve goals, and make decisions. He or she has three fundamental needs: the need for health information when it is needed and can be used; the need for care that seeks to prevent illness; and the need for care when he or she is unable to help him or herself.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

Health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of resources to achieve maximum potential for daily living. Environment is the background for human interaction. It involves the internal and external environments. The internal environment transforms energy to enable a person to adjust to continuous external environment changes. The external environment involves formal and informal organizations.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY. In this model, the nurse is part of the patient's environment.

The Theory of Goal Attainment defines nursing as "a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation" and "a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals." In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles. The domain of the nurse "includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying." The function of a professional nurse is "to interpret information in the nursing process to plan, implement, and evaluate nursing care." PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

King gives detailed information about the nursing process in her model of nursing. The steps of the nursing process are: assessment, nursing diagnosis, planning, implementations, and evaluation.

The theory explains that assessment occurs during interaction. The nurse brings special knowledge and skills whereas the patient brings knowledge of him or her self, as well as the perception of problems of concern to the interaction. During the assessment, the nurse collects data regarding the patient including his or her growth and development, the perception of self, and current health status. Perception is the base for the collection and interpretation of data. Communication is required to verify the accuracy of the perception, as well as for interaction and translation.

The nursing diagnosis is developed using the data collected in the assessment. In the process of attaining goals, the nurse identifies problems, concerns, and disturbances about which the patient is seeking help.

After the diagnosis, the nurse and other health care team members create a care plan of interventions to solve the problems identified. The planning is represented by setting goals and making decisions about the means to achieve those goals. This part of transaction and the patient's participation is encouraged in making decisions on the means to achieve the goals.

The implementation phase of the nursing process is the actual activities done to achieve the goals. In this model of nursing, it is the continuation of transaction.


Evaluation involves determining whether or not goals were achieved. PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.The explanation of evaluation in King's theory addresses meeting goals and the effectiveness of nursing care.

ORLANDO’S Nursing Process Theory-HELP PT. NEEDS

The Dynamic Nurse-Patient Relationship , published in 1961 and written by Ida Jean Orlando, described Orlando's Nursing Process Discipline Theory. The major dimensions of the model explain that the role of the nurse is to find out and meet the patient's immediate needs for help. The patient's presenting behavior might be a cry for help. However, the help the patient needs may not be what it appears to be. Because of this, nurses have to use their own perception, thoughts about perception, or the feeling engendered from their thoughts to explore the meaning of the patient's behavior. This process helps nurses find out the nature of the patient's distress and provide the help he or she needs.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.

The concepts of the theory are: function of professional nursing, presenting behavior, immediate reaction, nursing process discipline, and improvement.

The function of professional nursing is the organizing principle. This means finding out and meeting the patient's immediate needs for help. According to Orlando, nursing is responsive to individuals who suffer, or who anticipate a sense of helplessness. It is focused on the process of care in an immediate experience, and is concerned with providing direct assistance to a patient in whatever setting they are found in for the purpose of avoiding, relieving, diminishing, or curing the sense of helplessness in the patient.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY. The Nursing Process Discipline Theory labels the purpose of nursing to supply the help a patient needs for his or her needs to be met. That is, if the patient has an immediate need for help, and the nurse discovers and meets that need, the purpose of nursing has been achieved.

Presenting behavior is the patient's problematic situation. Through the presenting behavior, the nurse finds the patient's immediate need for help. To do this, the nurse must first recognize the situation as problematic. Regardless of how the presenting behavior appears, it may represent a cry for help from the patient. The presenting behavior of the patient, which is considered the stimulus, causes an automatic internal response in the nurse, which in turn causes a response in the patient.

The immediate reaction is the internal response. The patient perceives objects with his or her five senses. These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act. These three items are the patient's immediate response.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY. The immediate response reflects how the nurse experiences his or her participation in the nurse-patient relationship.

The nursing process discipline is the investigation into the patient's needs. Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his or her need, or finding out he or she has no needs at that time. The nurse cannot assume that any aspect of his or her reaction to the patient is correct, helpful, or appropriate until he or she checks the validity of it by exploring it with the patient. The nurse initiates this exploration to determine how the patient is affected by what he or she says and does. Automatic reactions are ineffective because the nurse's action is determined for reasons other than the meaning of the patient's behavior or the patient's immediate need for help.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY. When the nurse doesn't explore the patient's reaction with him or her, it is reasonably certain that effective communication between nurse and patient stops.

Improvement is the resolution to the patient's situation. In the resolution, the nurse's actions are not evaluated. Instead, the result of his or her actions are evaluated to determine whether his or her actions served to help the patient communicate his or her need for help and how it was met. In each contact, the nurse repeats a process of learning how he or she can help the patient. The nurse's own individuality, as well as that of the patient, requires going through this each time the nurse is called upon to render service to those who need him or her.

Orlando's model of nursing makes the following assumptions:

  • When patients are unable to cope with their needs on their own, they become distressed by feelings of helplessness.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.
  • In its professional character, nursing adds to the distress of the patient.
  • Patients are unique and individual in how they respond.
  • Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child.
  • The practice of nursing deals with people, environment, and health.
  • Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency needs.
  • People are able to be secretive or explicit about their needs, perceptions, thoughts, and feelings.
  • The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient.
  • People attach meanings to situations and actions that aren't apparent to others.
  • Patients enter into nursing care through medicine.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.
  • The patient is unable to state the nature and meaning of his or her distress without the help of the nurse, or without him or her first having established a helpful relationship with the patient.
  • Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or her need, or finding out that he or she is not in need at that time.
  • Nurses are concerned with the needs the patient is unable to meet on his or her own.

The nurse uses the standard nursing process in Orlando's Nursing Process Discipline Theory, which follows: assessment, diagnosis, planning, implementation, and evaluation. The theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement. Orlando's key focus was the definition of the function of nursing. The model provides a framework for nursing, but the use of her theory does not exclude nurses from using other nursing theories while caring for patients.PSYCHOTHERAPY WITH INDIVIDUALS PRACTICUM ESSAY.