Journey Across the LifespanTheories of Growth and DevelopmentText source:: Journey Across the Life Span: Health Development and Health Promotion Elaine Polan and Daphne Taylor

Objectives

Growth and Development

Growth and Development• Growth refers to an increase in physical size• Quantitative…measured in inches, centimeters, pounds, etc.

• Development refers to the progressive acquisition of skills

Growth and Development• Both can occur at the same time and interdependent.

• What does interdependent mean related to growth and development?

Development• Comes about through learned behavior• Comes about through maturation

• Maturation : attainment of full development

Growth and Development

What are two major influences on growth and development?

Growth and Development Assumptions

Assumption 1

Growth and development occur in an orderly pattern from simple to complex, one task must be accomplished before the next one can is attempted.Give an example….

Growth and Development Assumptions

• Assumption # 2

• Growth and development are continuous processes characterized by spurts of growth and periods of slow, steady growth.

• What are times of growth spurts?

Growth and Development Assumptions

• Assumption # 3

• Growth and development progress at highly individualized rates that vary from growth timetables, and one child’s growth pattern should not be compared to another

Growth and Development Assumptions

• Assumption #4

• Growth and development affect all body systems but at different times for specific structures. Although many organs mature and develop throughout childhood, the reproductive organs mature at adolescence.

Growth and Development Assumptions

• Assumption #5

• Growth and development form a total process that affects a person physically, mentally and socially.

Personality• What is the definition of personality?

• What influences personality?

• Why is it important to understand personality as a health care professional?

Psycho-analytical Theory

• Think Sigmund Freud!•Being entirely honest with oneself is a good exercise.Sigmund Freud

Sigmund Freud• Freud lays the ground work for all other personality theories

• 3 parts of his theory include levels of awareness, components of personality or the mind and psychosocial stages of development.

• According to Freud there are 3 levels to awareness that include:

• Conscious• Subconscious• Unconscious

Sigmund Freud• Conscious level refers to all those experiences that are within

one’s immediate awareness. Based on reality and logic.

• Subconscious or preconscious is the level awareness which stores thoughts, memories and feelings

• They can be recalled with little effort

• Unconscious level refers to the part of the mind that is closed to one’s awareness. These stored memories are usually painful and are kept in the unconscious to prevent anxiety and stress.

Sigmund Freud• Freud believed that we can understand behavior if we look

into the forces of the unconscious mind.

• The levels of awareness are the basis for Freud’s theory on psychoanalysis

• Also believe in three function units of the mind:

• Id……..Ego……..Superego

Id refers to body’s primitive urges

EGO part that is most closely related to reality. Developed related to the id and forces from the environment

Superego: further development of the ego. It judges, controls and punishes. Dictates right from wrong

ID………EGO…….SUPEREGO

• They are always in conflict with one another

• Ideally a balance or compromise should be reached among them

Id……Ego…….Superego

Example of conflicts:Id states, “I want it now!”Superego states, “You can’t have it.”Ego states, “Maybe later.”

Libido

• Driving behavior behind most of our actions

• Pleasure principle

• Sexual desire

• Part of the id, ego or super-ego?

Defense Mechanisms

• Techniques used at all stages of the life cycle to help individuals cope with the threat of anxiety.

• Sigmund Freud first recognized these defense mechanisms used to protect the ego.

• Most mechanisms are at the unconscious level (except suppression).

Defense Mechanisms

• Can be harmful or helpful• Allows the person to adjust to stress while

developing acceptable coping mechanisms• Some defense mechanisms are said to be

maladaptive• The frequency and intensity of the defense

mechanisms use will determine if they help or hinder• Protects our ego

Types of Defense Mechanisms

• 1. Suppression: operates on conscious level. Conscious puts out of awareness the distressing thought.

• Can be brought back into focus anytime

• All individuals use suppression as a means of concentrating.

Types of Mechanisms

• Rationalization: Most widely used by all age groups• Used to justify or excuse actions or

feelings.• Can prevent individuals from facing reality

Can you give me an example?

Types of Mechanisms

Identification: one person takes on the personality traits of another person, usually one held in high esteem.

Give an example…

Types of Mechanisms

• Sublimation: Individual redirects unacceptable impulses into socially acceptable outlets.

• Most of these mechanisms involve primitive drives

• Considered to be a positive coping mechanism.• Can you give an example?

Types of Mechanisms

• Regression: individual facing a conflict returns to an earlier developmental phase.

• Example?

Types of Mechanisms

• Denial: used totally on the unconscious level. Used when an individual is confronted with an unbearable news.

• Person is unable to recognize the event or emotions surrounding the occurrence.

• Example..

Types of Mechanisms

• Displacement: Transfers emotions associated with a person or object to another less threatening person or object.

• Example…

Types of Mechanisms

• Projection: often referred to as blaming principle. Person rejects unacceptable thoughts or feelings and attributes this to another person.

• Example

Types of Mechanisms

• Compensation: Allows the person to make up for deficiencies by excelling in another area.

• Example

Types of Mechanisms

• Undoing: Individual acts in a manner that symbolically cancels a previous unacceptable thought or action. Individual attempts to make up for something unacceptable.

• Example….

Types of Mechanisms

• Reaction Formation: also known as over compensation. Unacceptable feelings or thoughts are kept out of one’s awareness and replaced with opposite feelings or thoughts. “Pretender”

• Example

Types of Mechanisms

• Conversion: Mental mechanism that converts unconscious feelings and anxiety into a physical symptom with no organic basis.• Example

Types of Mechanisms

• Repression: Mental mechanism that unconsciously excludes painful experiences, thoughts or feelings from awareness.• Individual can not recall the experience

but it influences their behavior• Causes internal conflict

Types of Mechanisms

• Adaptive•Maladaptive

Freud Theory: Linked to sexual development• Called Psycho-sexual Theory• Freud described 5 stages• Each stage is associated with a particular

conflict• Conflict must be resolved before the child

can move on to the next stage.

Stage 1: Oral Stage

Stage 2: Anal Stage

End of first year of life to the third yearMouth continues to be important source of satisfaction for the childAt this stage the organs of elimination give the child pleasure and satisfactionToilet training initially experienced as a conflict between the child and parent

Stage 3: Phallic Stage

• Age 3 to 6

• Child associates pleasurable and conflicting feelings with their genitalia

•Masturbation and examination of the genitalia are normal

Stage 3: Phallic stage

• Oedipus and Electra Complex

•What is it?

Stage 4: Latency Stage

• Ages 6 to 12 years of age• Sexual urges are dormant• Child focuses on intellectual pursuits• Peer relationships are important

Stage 5: Genitals Stage

• Onset of puberty• Physical changes occur• Hormonal and sexual organ maturation• Awakening of sexual attraction

So, how do I use this information to make decisions about my patients and to be successful on NCLEX-PN questions?

Know…• Normal Physical Development• Psychosocial development is predictable and is observed to

occur in a pattern across the years• Nursing care for patients should be planned according to their

developmental age, not their chronological age• How to identify that your patient is using coping mechanisms

and discuss alternative coping strategies

Let’s try a question related to copingThe patient suffers from hyperactivity/ADHD. It would be most appropriate for the nurse to perform which of the following interventions?

a. Give the patient materials to make a collageb. Encourage the patient to use an exercise bikec. Encourage the patient to attend a group about managing

feelingsd. Ask the client to play a board game with other patients

The answer is B

1. Hyperactivity/ADHD does not lend itself well to the patience and organization need to complete a collage.

2. The exercise bike would allow an outlet for the client’s excessive energy

3. This patient does not have the patience to sit in a group and discuss their feelings. This is not appropriate

4. During a hyperactivity episode, patients do not have the patience to play a board game.

While the nurse is explaining necessary lifestyle changes to a client with angina, the client continually changes the subject. The nurse determines that this coping mechanism is:

a. denialb. angerc. anxietyd. depression

The Answer is A

Denial is a defense mechanism that allows the client to minimize a threat; it may be manifested by a refusal to discuss what has happened. Denial is a common early reaction associated with chest discomfort, angina, or myocardial infarction. Anger is often manifested by "acting out" behaviors. Anxiety is usually manifested as a result of symptoms of sympathetic nervous system arousal. Depression may be manifested by passive behaviors.

A client who has a new feeding gastrostomy tube refuses to participate in the plan of care, will not make eye contact, and does not speak to family or visitors. The nurse recognizes that this client is using which ineffective coping mechanism?

a. distancingb. self-controlc. problem solvingd. accepting responsibility

The Answer is A

Distancing is an unwillingness or inability to discuss events. Self-control is demonstrated by stoicism and hiding feeling. Problem solving involves making plans and verbalizing what will be done. Accepting responsibility places the responsibility for a situation on one's self.

Erik Erikson: Psychosocial Theory• Psychologist and close friend of Freud• Broadened Freud’s Theory of Personality

Development• Erik Erikson identified eight stages that

span the full life cycle from infancy to old age.• Studied child in a larger social setting

beyond the immediate family

Stage 1: Trust vs. Mistrust

• Birth to 18 months child is helpless and totally dependent on others

• If needs are met appropriately the child develops trust in others

• Trust is built by consistency and sameness of care givers.• Trust is the foundation of a healthy

personality.

Stage 2: Autonomy vs. Shame and Doubt• 18 months to 3 years• Child begins to gain control over his or her

body and develop a sense of independence or autonomy• Autonomy is characterized by the

acquisition of skills• Independence fosters self concept.

Requires love and support from the environment

Stage 3: Initiative vs. Guilt

• 3 years to 6 years• Child explores the environment and tries

different roles• Imagination and curiosity allow the child

to further develop• Parents allow the child to explore within

safe boundaries•Without freedom children may develop

guilt and feelings of inadequacy

Stage 4: Industry vs. Inferiority

• 6 to 11 years• Child acquires many new social and

physical skills• School age children have the maturity to

concentrate on learning and working with others.• Family life should be supportive•Without positive responses, children may

develop inferiority

Stage 5: Identity vs. Role Confusion12 to 20 yearsTransitional between childhood and adulthoodPhysiological and emotional changesEmerging issues of sexuality and the need to find their place in societyRole confusion occurs if the individual does not have love and support

Stage 6: Intimacy vs. Isolation

• 20 to 30 years• Goal to develop meaningful relationships• Develop committed relationship• This is learned within the family unit• Failure to develop close relationships

result in loneliness and isolation

Stage 7 Generativity vs Stagnation•Middle age focuses on leadership,

productivity and concern for the future• Ages 30 to 65 years of age• Individuals reflect on accomplishments• Generativity takes on different forms• Stagnation occurs when the person is

unconcerned for the welfare of others.

Stage 8: Ego vs. Despair

• Life experiences are reviewed• Ego integrity is achieved• Person accepts the past• Person has a sense of dignity from

accomplishments• Despair can produce worthlessness

So, how do I use this information to make decisions about my patients and to be successful on NCLEX-PN questions?

Sample NCLEX-PN Questions related to G&D - EriksonA nursing assistant becomes frustrated by the two-year old child’s persistent response of “No” whenever she asks her to do something. The nursing assistant asks the nurse the nurse for help.

What is the best suggestion the nurse can give the nursing assistant caring for the two-year old child at this time?a. Let the child choose from two acceptable alternativesb. Withhold something the child desires until she complies.c. Identify what is expected of the child, rather than ask.d. Tell the child that her mother will be told if she refuses to

cooperate.

The Answer is C

To exercise autonomy, the toddler often becomes defiant and refuse to cooperate with requests, routines, and regulations. At this time, the toddler does not understand the need to abide by rules and requests outside of his or her wants. This often frustrates parents who are trying to guide the toddler. They psychosocial characteristics of integrity, identity, and generativity are acquired at later states of development.

Which diversional activity is most appropriate for the 7 year old child during the acute phase of rheumatic fever?

a. Playing with action figures.b. Playing video games.c. Reading an adventure story.d. Pounding wooden pegs with a mallet.

The answer is C

Reading an adventure story would be the most appropriate activity for the child during the acute phase of the illness. The child will need both physical and emotional rest; therefore, quiet, age-appropriate activities are recommended to prevent overexertion as well as boredom and emotional upset that may occur if the child is not permitted any activity. Preschoolers usually enjoy playing with action figures; also, this activity may cause excitement, which will increase energy consumption. Video games may also cause too much excitement. Toy mallets and wooden pegs are more appropriate for a toddler.

Piaget’s Cognitive Theory

Jean Piaget

• Contributed to the field of cognitive development• How an individual acquires intellect and

develops thought processes• Believe intelligence was an innate ability

that further developed as the child adapts to the environment• Believes child progresses through four

stages

Cognitive Development

• Stage 1: Sensory motor Stage Birth to 2 years• Infant responds to the environment• Acquires knowledge through exploration

and attaching meaning and recognition to things• Trial and error behavior

Cognitive Development

• Stage 2: Preoperational Stage• 2 years to 6 years•Mastery of language• Child sees self as the center of the

universe• Unable to accept others viewpoints

Cognitive Theory

• Stage 3: Concrete Operational • 6 to 12 years• Child beginning to think logically and solve

problems• Understand concepts

Cognitive Theory

• Formal Operational• Ages 12 years to 15 years• Person has the ability to think logically and

in abstract terms• Capability of scientific reasoning and

problem solving

So, how do I use this information to make decisions about my patients and to be successful on NCLEX-PN questions?

Which teaching aid is developmentally appropriate for a preschooler who is about to have a bone marrow puntcure?

a. Dolls or puppetsb. Pamphlets or bookletsc. Colored diagramsd. Commercial videotapes

The Answer is A

Using dolls or puppets as a teaching aid is the most appropriate strategy for a preschooler’s cognitive ability. Pamphlets and diagrams are too abstract for the cognitive level of children who are 3, 4, or 5 years of age. The use of videotape might be confused as a form of entertainment rather than personal instruction.

Human Needs Theory: Maslow

Maslow

• Abraham Maslow • Behavior is motivated by needs that are

ordered• Bottom of the triangle begins with basic

needs. Maslow believes basic needs must be met first before higher needs

Maslow

Triangle Base Physiologic Needs

• Physiological needs include oxygen, food, water, rest, shelter, sexual and elimination.

Maslow• Safety Needs:• Need to feel secure,

safe and free from danger

Maslow• Belonging:

Need to feel loved and accepted by another person• All individuals need

affection and meaningful relationships

Maslow• Self Esteem:• People need to feel

good about themselves and their accomplishments• Person must have

approval and recognition

Maslow• Self Actualization• Means fulfillment• Fulfillment of ones

potential• Maslow did not

believe everyone can be self actualized• People become more

comfortable with themselves.

NCLEX-PN Alert

Maslow’s Hierarchy is very useful in answering test questions related to setting priorities. Always remember the physiological needs at the base of the pyramid must be satisfied in order to focus on other needs and that oxygenation is always first priority.

An hour after admission to the nursery, the LPN observes a newborn baby having spontaneous jerky movements of the limbs. The infant’s mother had gestational diabetes mellitus (GDM) during pregnancy. Which of the following actions should the LPN take first?

a. Give dextrose water.b. Call the physician immediately.c. Determine the blood glucose level.d. Observe closely for other symptoms.

The answer is C

You should have recognized that the baby’s jerky movements as an indication of hypoglycemia. Don’t forget that an important part of the data collection process is validating what you observe. You must complete data collection before you plan and implement nursing care.

Did a situation like this ever happen while you were at work?You are called to a patient’s room by a family member and find the patient lying on the floor. He is bleeding from a wound on the forehead, and his indwelling catheter is dislodged and hanging from the side of the bed.

Where do you begin? Do you call for help? Do you return him to bed? Do you apply pressure to the cut? Do you reinsert the catheter? Do you call the doctor? What do you do first? This is why establishing priorities is so important.

Typical Nursing School Question as it relates to prioritizingWhich of the following would most concern the LPN during a patient’s recovery from surgery?

a. Safetyb. Hemorrhagec. Infectiond. Pain Control

You have no opportunity to ague an NCLEX-PN question. Critical thinking is required for priority questions.

Using Maslow’s strategy, the nursing process strategy, and the safety strategy will help you with prioritizing questions.

Maslow’s Strategy

Because physiological needs are necessary for survival, they have highest priority and must be met first. Physiological needs include oxygen, fluid, nutrition, temperature, elimination, shelter, rest, and se. If you don’t have oxygen to breathe or food to eat, you really don’t care if you have a stable psychosocial relationships!

Safety needs can be both physical and psychosocial. Physical safety includes decreasing what is threatening to the client. The threat may be an illness, accidents, or environmental threats.

To attain psychological safety, the patient must have the knowledge and understanding about what to expect from others in his environment. For example, it is important to teach the patient and his family what to expect after a CVA.

To achieve love and belonging, the patient needs to feel loved by family and accepted by others.

The highest level of Maslow’s hierarchy of needs is self-actualization. To achieve this level the patient must experience fulfillment and recognize his or her potential. All levels of Maslow’s theory must be met to gain self-actualization.

Using Maslow’s Theory

Step 1 – Look at your answer choices. If answer choices are both physical and psychosocial, it’s time to “Maslow” the answer choices.

Step 2 – Eliminate all psychosocial answer choices. If an answer choice is physiological don’t eliminate it yet. Remember, Maslow states that physiological needs must be met first. While pain certainly has a physiological component, reactions to pain are considered “psychosocial” on the NCLEX-PN exam.

Step 3 – Ask yourself: Does this choice make sense?

Step 4 – Can you apply the ABC’s?

A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled. Preoperatively, which of the following goals is most important for the LPN to include on the patient’s plan of care?a. Fluid replacementb. Pain reliefc. Emotional supportd. Respiratory therapy

Look at the stem of the question:

A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled. Preoperatively, which of the following goals is most important for the LPN to include on the patient’s plan of care?

Important = priority

Step 1 – Look at your answer choicesa. Fluid replacementb. Pain reliefc. Emotional supportd. Respiratory therapy

There are both physical and psychosocial interventions included

Step 2 – Eliminate psychosocial interventions

a. Fluid replacementb. Pain reliefc. Emotional supportd. Respiratory therapy

Step 3 – Ask yourself, “Does this make sense?”

Fluid replacement makes sense, because this patient has a ruptured ectopic pregnancy.

Respiratory therapy does not make sense with a ruptured ectopic pregnancy. The obstetrical patient is not likely to need respiratory care prior to surgery.

The LPN implements care for a 14 year old girl admitted with an eating disorder. On admission, the girl weighs 82 lbs. and is 5’4” tall. Lab tests indicate severe hypokalemia, anemia, and dehydration. The LPN should give which of the following nursing diagnoses the highest priority?

a. Body image disturbance related to weight lossb. Self-esteem disturbance related to feelings of inadequacyc. Altered nutrition: less than body requirements related to

decreased intake.d. Decreased cardiac output related to the potential for

dysrhythmias.

Step 1 – Look at your answer choices

a. Body image disturbance related to weight lossb. Self-esteem disturbance related to feelings of inadequacyc. Altered nutrition: less than body requirements related to

decreased intake.d. Decreased cardiac output related to the potential for

dysrhythmias.

There are both physical and psychosocial interventions included

Step 2 – Eliminate any answer choices that are psychosocial

a. Body image disturbance related to weight lossb. Self-esteem disturbance related to feelings of inadequacyc. Altered nutrition: less than body requirements related to

decreased intake.d. Decreased cardiac output related to the potential for

dysrhythmias.

Step 3 – Ask yourself: Does “altered nutrition” make sense?Does “decreased cardiac output” make sense?a. Altered nutrition: less than body requirements related to

decreased intake.b. Decreased cardiac output related to the potential for

dysrhythmias.

Step 4 – Use the ABC’s

Theory of Moral Development

Theory of Moral Development

• Lawrence Kohlberg• Introduced theory, expanded Piaget’s

stages of cognitive development• Believes child progressively develops

moral reasoning as he/she gains the ability to think logically

3 Levels with 6 stages

• Level 1 (4 to 10 years) Pre-conventional Thinking• Child learns reasoning through parents

demands for obedience• Child begins to recognize right from wrong

Three levels

• Level II (10 to 13 years)• School age child begins to seek approval

from society.• Child influenced by external forces in

interactions with peers and the environment

Three Levels

• Level III• Post Conventional Thinking• Adolescents develop their own moral

codes.•Moral reasoning is based on the

individuals own principles rather than external forces• Act on internal beliefs

Understanding Moral Development• Helps nurses to understand patients• Helps nurses to understand moral

reasoning and working through ethical issues.

Don’t forget we won’t see knowledge base questions on NLCEX-PN but will see them in nursing school.

Which of the following statements reflects Kohlberg’s theory of the moral development of the preschool-age child?

A. Obeying adults is seen as correct behavior. B. Showing respect for parents is seen as important. C. Pleasing others is viewed as good behavior. D. Behavior is determined by consequences.

Test Review

According to Erikson, the foundation for a healthy personality is:

• 1. Trust• 2. Autonomy• 3. Intimacy• 4. Ego Integrity

• 1. Self Actualization• 2. Physiological• 3. Safety• 4. Belonging

Your 72 year old patient with congestive heart failure is complaining of shortness of breath, so he may be unable to satisfy which of the following needs?

Freud states that the driving force behind all human behavior is?

• 1. Libido• 2. Superego• 3. Ego• 4. Id

Individuals utilize defense mechanisms to:

• 1. Explain life situations• 2. Reduce anxiety• 3. Provide pleasure• 4. Perceive boundries

An elderly woman recently admitted to the nursing home is exhibiting tantrums of crying and foot stomping when family members visit. This behavior is associated with which coping strategy?

• 1. Displacement• 2. Denial• 3. Rationalization• 4. Regression

Identify from the list, Erikson’s developmental task…

• 1. “I can do it myself”• 2. “Oh, I am old and alone and it doesn’t matter what I do

anymore”• 3. “I am pretending to be mommy, you can make believe you

are daddy”• 4. “I would rather stay home and play with the baby sitter

while you to the store. I know that you will be back.”• 5. “I am not afraid to die, I’ve lived a good, long life”

Based on Piaget’s theory, which cognitive ability would these individuals demonstrate?

• 1. 4 year old Donte• 2. 10 year old Sybil

What characteristics would someone show that is a self actualizer?

Test• Multiple choice• Short answer • Need to know each of the theorist discussed and their beliefs