Chapter 11: Developmental Theories 3

Psychoanalytical / psychosocial theory

Describe human development from the perspectives of personality, thinking, and behavior. Explains development is primarily unconscious and influenced by emotion. Unconscious drives influence development through universal stages experienced by all individuals

Erik Erikson's theory of psychosocial development

Development occurs throughout the lifespan and is focused on psychosocial stages. Individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one. Each task is framef with opposing conflicts, and tasks once mastered are challenged and tested again during new situations or at times of conflict.

Sensorimotor (birth to 2 years)

During this stage the child learns about himself and his environment through motor and reflex reactions. They learn that they are separate from the environment and aspects of environment continue to exist even though they cannot always be seen. Object permanence

Gesell's theory of development

Each child pattern of growth is unique and this pattern is directed by gene activity. The pattern of maturation follows a fixed developmental sequence in humans. Sequential development is evident in fetuses, in which there is a specified order of organ system development.

Initiative versus guilt (3 to 6 years)

Fantasy an imagination allows them to further explore their environment. In this time they are developing their superego, or conscience. Conflicts often occur between the child's desire to explore and the limits placed on his or her behavior. These conflicts sometimes lead to feelings of frustration and guilt. Successful resolution of the stage results in direction and purpose.

generativity vs. Self-absorption and stagnation (middle age)

Focuses on supporting future generations. The ability to expand one's personal and social involvement is going to go on this stage of development. Achieve success in this stage by contributing to future generations through parenthood, teaching, and community involvement. Inability to play a role in the development of the next generation results in stagnation

bio physical development

How are physical bodies grow and change

identity vs role confusion (puberty)

Identity development begins with the goal of achieving some perspective or direction, answers the question, Who am I? Acquiring a sense of identity is essential for making adult decisions such as choice of location or marriage partner. New social demands, opportunities, and conflicts that relate to the emergent identity and separation from family.

Jean Piaget's theory of cognitive development

Includes four periods are related to age and demonstrate specific categories of knowing and understanding. Individuals move from one state to another seeking cognitive equilbrium or state of mental balance

This social contract orientation

Individual follows the societal law but recognizes the possibility of changing the law to improve society. Recognizes that different social groups have different values but believes that all rational people would agree on basic rights such as liberty and life. Make more of an independent effort to determine what society should value rather than what the society as a group would value

Oral (birth to 12 to 18 months)

Initially sucking and oral satisfaction are not only vital to life but are also extremely pleasurable in their own rights.

Cognitive processes

Intelligence, understanding, thinking

Preoperational 2 to 7 years

Learn to think with the use of symbols and mental images. They exhibit egocentrism and that they see objects and persons from only one point of view, their own. They believe that everyone experiences the world exactly as they do. They believe that inadament object have life like thought, wishes, and feelings

Integrity vs. Despair (old age)

Many older adults review their lives with a sense of satisfaction, even with their inevitable mistakes. Others see themselves as failures, with their lives Marked by despair and regret. Interpret their lives as a meaningful whole or experience regret because goals not achieved. External struggles are met with internal struggles

Conventional reasoning level 2

Person sees more reasoning based on his or her own personal internalization of societal and others expectations. A person wants to fulfill their expectations of the family, group, or nation and also develop a loyalty to an actively maintain, support, and justify the order . Emphasis now is on social rules and a community centered approach

Socio emotional factors

Personality, emotions, relationships with others

biological process

Physical growth and development

Maslow's theory of human needs

Physiological, safety, belonging / love, esteem, and self-actualization

Developmental theories

Proposed ways to account for how and why people grow as they do, provide a framework for examining, describing, and appreciating human development. Helps nurse assess and treat a patient's response to an illness

Latency (6-12 years old)

Sexual urges expressed in the earlier oedipal stage are repressed and channeled into productive activities that are socially acceptable. Within the educational and social worlds of the child, there is much to learn and accomplish

Genital (puberty through adulthood)

Sexual urges reawaken and are directed to an individual outside the Family Circle. Unresolved park on sex service during adolescence. Once the individual resolves conflicts, they are than capable of having a mature adult sexual relationship

Punishment and obedience orientation

Stage 1. A child's response to a moral dilemma is in terms of absolute obedience to authority and rules. Avoiding punishment or that I'm questioning deference to authority is a characteristic motivation to behave

Instrumental relativist orientation

Stage 2. Child recognizes that there is more than one right view. The decision to do something morally right is based on satisfying one's own needs and occasionally the needs of others. The child receives punishment not as proof of being wrong but as something that one wants to avoid

Concrete operations 7 to 11 years

Are not able to perform mental operations. Able to describe a process without actually doing it. Able to coordinate to concrete perspectives and social and scientific thinking so that they are able to appreciate the difference between their perspective and that of a friend.

Temperament

Behavioral style that affects an individual's emotional interactions with others

Autonomy versus shame and sense of doubt (1-3 years)

Child gains new found independence (because of being able to walk, feed themselves, and toilet) and they begin to develop autonomy by making choices. These choices include activities related to relationships, desires, and play things. There is also an opportunity to learn that parents and society has expectations about these choices. Limiting choices and/or enacting harsh punishment leads to feelings of shame and doubt. The toddler who successfully masters this stage achieves self control and willpower.

Principles of development

Continuous process through life, orderly sequence, predictable but unique ranges, systems mature at different rates, more rapid in early periods.

Good boy - nice girl orientation

Stage 3. Then dividual wants to win approval and maintain their expectations of one's immediate group. Being good is important and defined as having good motives, showing concern for others, and keeping mutual relationships through trust, loyalty, respect, and gratitude. One earns approval by being nice

Society maintaining orientation

Stage 4. Individuals expand their focus from the relationship with others to societal concerns . Moral decisions taken 2 accounts aside all perspectives. Right behavior is doing one's duty, showing respect for authority, and maintaining the social order

Universal ethical principle orientation

Stage 6. Defines right by the decision of conscience in accord with self chosen ethical principles. These principles are abstract and appeal to logical comprehensiveness, universality, and consistency

Sigmund Freud's psychoanalytical model of personality development

States that individuals go through five stages of psychosexual development and that each stage is characterized by sexual pleasure and parts of the body: the mouth, the anus, and the genitals. Adult personality is the result of how an individual resolve conflicts between these sources of pleasure and the mandates of reality. The components of the human personality develops in stages and regulate behavior. These components are the id, the ego, and the super ego m

Anal (12-18 months -3 years)

The focus is pleasure changes to the anal zone. Children become increasingly aware of the pleasurable sensations of the body region with interest in the products of their efforts. Potty training

Lawrence Kohlberg's theory of moral development

6 stages of moral development under three levels

The teaching plan for a 3-year-old child who is at risk for developmental delay should include which of these instructions for the parents? a. Encourage play as your child is exploring his or her surroundings. b. Insist that your child discuss various points of view, not just his or her own. c. Discuss world events with your child to foster language development. d. Actively encourage your child to read lengthy books to expedite reading and writing abilities.

ANS: A A 3-year-old child is going to use play to learn and discover the surrounding environment. Children at this age are egocentric and often are unable to see the world from any perspective other than their own. Very young children are not able to understand and comment on world events because their thinking has not advanced to abstract reasoning yet. A 3-year-old child is likely unable to read. Asking a child to perform an activity that is beyond his or her developmental abilities will likely result in frustration at not being able to complete the task.

The nurse is teaching a young adult couple about promoting the health of their 8-year-old child. The nurse knows that the parents understand the developmental stage their child is in according to Erikson when they state, "We should a. Provide proper support for learning new skills." b. Encourage devoted relationships with others." c. Limit choices and provide harsh punishment for mistakes." d. Not leave our child at school for longer than 3 hours at a time."

ANS: A An 8-year-child would be in the industry versus inferiority stage of development. During this stage, the child needs to be praised for accomplishments such as learning new skills. Developing devoted relationships is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame and doubt. Separation anxiety is usually a part of the trust versus mistrust stage.

The nurse knows that a priority reason for being knowledgeable about biophysical developmental theories is to a. Understand how the physical body grows. b. Predict definite patterns of cognitive development. c. Anticipate how patients' social behaviors develop. d. Describe the process of psychological development.

ANS: A Biophysical development refers to how our physical bodies grow and change. Nurses and other health care providers are able to quantify and compare the changes that occur as a newborn infant grows into adulthood against established norms to detect abnormalities. Biophysical development refers to physical growth, not cognitive development, social behaviors, or psychological development.

When utilizing Freud's psychoanalytical/psychosocial theory, the nurse recalls that a. Adult personality is the result of resolved conflicts between sources of sexual pleasure and the mandates of reality. b. Development occurs throughout the life span and focuses on psychosocial stages. c. The genital stage precedes the phallic stage of development. d. Problems evident in adult life are due to early successes and resolution of earlier developmental stages.

ANS: A Freud believed that adult personality is the result of how an individual resolved conflicts between sources of sexual pleasure and the mandates of reality. Freud had a strong influence on Erik Erikson, but Erikson's theory differed from Freud's in that it focused on psychosocial stages rather than psychosexual stages. Freud's five stages of psychoanalytical development in sequential order include oral, anal, phallic, latency, and genital. The phallic stage precedes the genital stage. In theory, problems in adult life would be due to unresolved conflicts and failures.

Jean Piaget's cognitive developmental theory focuses on four stages of development, including a. Formal operations. b. Intimacy versus isolation. c. Latency. d. The postconventional level.

ANS: A Jean Piaget's theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations, and formal operations. Intimacy versus isolation is part of Erik Erikson's psychosocial theory of development. Latency is stage 4 of Freud's five-stage psychosexual theory of development. The postconventional level of reasoning is part of Kohlberg's theory of moral development.

The nurse is planning playroom activities for a hospitalized 6-year-old patient. Which of the following age appropriate items that the nurse should ensure are available? (Select all that apply.) a. Crayons and paper b. Children's books c. 500-piece puzzle d. Building blocks e. Magazines and newspapers

ANS: A, B, D A school-aged child thrives on feelings of accomplishment. Drawing pictures, looking at children's books, and building blocks are all ways that a child this age could play while developing a sense of accomplishment. A 500-piece puzzle would be too difficult for a 6-year-old child to complete without the possibility of getting frustrated. Magazines and newspapers would be written at too high a reading level for a 6-year-old child. If play items offered to the child are too difficult, the child may become frustrated and may experience a feeling of inferiority.

According to Piaget's theory of cognitive development, the nurse should allow a hospitalized 4-year-old patient to safely play with a. The pump administering intravenous fluids. b. The blood pressure cuff. c. A baseball bat. d. A book to read alone in a quiet place.

ANS: B A 4-year-old child would be in the preoperational period. Children at this stage are still egocentric. Play is very important to foster cognitive development. Children should be allowed to play with any equipment that is safe and should be allowed to communicate feelings about their health care. The IV pump is not a safe piece of equipment for a 4-year-old child to play with. A baseball bat typically is not found in a hospital setting and is a potentially dangerous toy to play with in the hospital. The blood pressure cuff is a safer option. A 4-year-old child is of preschool age and more than likely is not able to read yet. Also, the book does not allow for any human interaction and communication if read alone.

The parents of a 14-year-old boy express concern over their child's rebellious behavior. The nurse should plan to respond to the parents' concern by informing them that their a. Child should be referred to a juvenile correctional facility. b. Child's behavior is normal because the adolescent is trying to adjust to his emerging identity. c. Child's behavior is a matter of concern because he is likely conflicted about establishing companionship with a partner. d. Child's behavior is expected because he is expressing his need to support future generations.

ANS: B According to Erikson, a 14-year-old adolescent is developing his identity versus role confusion. A teenager is very concerned with self and is often preoccupied with body image. Frequently, teenagers express themselves rebelliously as they struggle to discover their own identities. Rebellious behavior is very common and normal at this stage of development. A juvenile correctional facility usually is not necessary. Establishing companionship occurs in the young adult age group. Feeling the need to support future generations is usually experienced by the middle-aged adult.

The parents of a 15-month-old child express concern to the nurse about their child's thumb-sucking habit. Which of these explanations related to the child's age and developmental level would be most appropriate for the nurse to give the parents? a. Thumb sucking at this age indicates a developmental delay and should be further assessed. b. Sucking achieves a pleasing result for infants, and generalizing that action by thumb sucking is normal. c. Thumb sucking at this age demonstrates a transition away from egocentric thinking. d. At this age, thumb sucking will enhance language development.

ANS: B Action patterns are used by infants and toddlers to deal with the environment. For example, the infant who learns that sucking achieves a pleasing result generalizes that action to suck fingers, blankets, or clothing. Children remain egocentric into the preoperational period. Thumb sucking does not indicate transition away from egocentric thinking. No statements have supported thumb sucking as enhancing language development.

An 18-month-old patient is brought into the clinic for evaluation because the mother is concerned. The 18-month-old child hits her siblings and says only "No" when communicating verbally. According to Piaget's theory, what recommendation should the nurse make a priority? a. Consult the social worker because the child is hitting other children. b. Reassure the mother that the child is developmentally within specified norms. c. Encourage the mother to seek psychological counseling for the child. d. Remove all toys from the child's room until this behavior ceases.

ANS: B At 18 months, the child is in the sensorimotor period of development. Piaget describes hitting, looking, grasping, and kicking as normal schemas to deal with the environment. The social worker does not need to be consulted in this case, nor is psychological counseling warranted, because the child is exhibiting normal behaviors. Play is an important part of all children's development. Removing the toys is not necessary because this child is exhibiting normal behaviors. Removing toys and the opportunity to play with them may actually hinder the child's development.

When developing a plan of care concerning growth and development for a hospitalized adolescent, what should the nurse do? (Select all that apply.) a. Stick with one developmental theory for consistency. b. Apply developmental theories when making observations of the individual's patterns of growth and development. c. Compare the individual's assessment findings versus established normal findings. d. Recognize his/her own moral developmental level. e. Apply a unidimensional life span perspective.

ANS: B, C, D No one theory successfully describes all the intricacies of human growth and development. Today's nurses need to be knowledgeable about several theoretical perspectives when working with patients. These theories form the basis for meaningful observation of an individual's pattern of growth and development. They provide important guidelines for an understanding of important human processes that allows the nurse to begin to predict human responses, not medical diagnoses, and to recognize deviations from the norm. Recognizing your own moral developmental level is essential in separating your own beliefs from those of others when helping patients with their moral decision-making process. Growth and development, as supported by a life span perspective, is multidimensional.

A nurse should instruct the parents of a 10-year-old child to keep which of the following theoretical principles in mind when dealing with a behavioral problem at home? a. Strategies that worked well with the first child will be equally as effective for the second child. b. Encourage the child to volunteer some time at a local hospital to instill a sense of fulfillment. c. Bargaining about chores in exchange for privileges may be an effective method of encouraging helpful activities. d. Do not offer praise for accomplishments and punishment for behavioral issues.

ANS: C In the concrete operations period, children begin to cooperate and share new information about the acts they perform. Parents will be able to adjust their approaches to guide the child into helpful activities within the home, such as bargaining about chores in exchange for privileges. With the birth of a second child, most parents find that the strategies that worked well with the first child no longer work at all. After birth, children grow according to their genetic blueprint and gain skills in an orderly fashion, but at each individual's own pace. The need for a sense of fulfillment is usually experienced by middle-aged adults, not children. School-aged children need praise to discourage a sense of inferiority; providing praise is the best choice for encouraging positive behaviors while nurturing growth and development.

According to Piaget's formal operations level, a 13-year-old adolescent will likely a. Hit other students to deal with environmental change. b. Use play to understand her surroundings. c. Question her parents about an upcoming presidential election. d. Question where the ice is hiding when ice has melted in her drink.

ANS: C In the formal operations period, adolescents and young adults begin to think about such subjects as achieving world peace, finding justice, and seeking meaning in life. Asking about a presidential election demonstrates that the adolescent is concerned about political issues that affect others besides her. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to 12 years), children are able to coordinate two concrete perspectives in social and scientific thinking, such as understanding the difference between "hiding" and "melting."

A formerly independent and active older adult becomes severely withdrawn upon admission to a nursing home. When approaching this patient, which intervention should the nurse plan first? a. Offer a reward for participation in all events. b. Encourage the patient to attend all social events scheduled for the patients. c. Allow the patient to incorporate personal belongings into her room. d. Advise the patient of the importance of attending mandatory activities.

ANS: C The older adult is in the mature thinking stages of development according to Piaget and Kohlberg. According to Gould, the older adult needs help in realistically appreciating his/her accomplishments and in fostering continued development. Erikson's theory proposes that the older adult faces integrity versus despair. To avoid despair, the nurse should allow the patient to actively participate in an independent activity, such as preparing his/her own room with personal belongings. Offering a reward does not address the need for continued independence. Encouraging participation in social events again does not address independence, and the question is asking for the best first intervention. Advising the patient to attend all mandatory activities as the first intervention does not allow for the patient's independence. Some activities may be mandatory, but by first allowing the patient to decorate her room, the nurse is fostering independence and is helping the patient feel welcome and more at home.

Which of these manifestations, if identified in a 6-year-old patient, should the nurse associate with a possible developmental delay based on Piaget's theory? a. The child speaks in complete sentences but often talks only about himself. b. The child still plays with a favorite doll that he has had since he was a toddler. c. The child continues to suck his thumb. d. The child describes an event from his own perspective, even though the entire family was present.

ANS: C This is a characteristic of the sensorimotor stage (birth to 2 years), where schemas become self-initiated activities. For example, the infant who learns that sucking achieves a pleasing result generalizes the action to suck fingers, blanket, or clothing. Successful achievement leads to greater exploration. By age 6, the child is in the preoperational stage of development. The child is expected to be egocentric, even though language ability is progressing. Play becomes a primary means by which children foster their cognitive development; therefore playing with a doll is considered normal at this age. Children see objects and persons from only one point of view—their own—at this stage.

Which of these statements would be most appropriate for a nurse to state when assessing an adult patient for growth and developmental delays? a. "How many times per week do you exercise?" b. "Are you able to stand on one foot for 5 seconds?" c. "Would you please describe your usual activities during the day?" d. "How many hours a day do you spend watching television or sitting in front of a computer?"

ANS: C Understanding normal growth and development helps nurses predict, prevent, and detect deviations from patients' own expected patterns. The nurse can then compare expected patterns of activity based on age with the patient's stated activity patterns to determine deviations from the patient's own expected patterns. Asking the patient to describe his/her usual daily activities will provide the nurse with useful information about the patient's own expected patterns. How many hours are spent watching television or in front of a computer and how many times the patient exercises in a week are closed-ended questions. These questions would not provide the nurse with as much information about the patient's expected patterns when his/her stated patterns are compared with expected patterns for the patient's age group to detect delays.

When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine the cause of the patient's behavior. From a growth and development perspective, what should the nurse recall? a. Individuals have uniform patterns of growth and development. b. Health is promoted based on how many developmental failures a patient experiences. c. Culture usually has no effect on predictable patterns of growth and development. d. When individuals experience repeated developmental failures, inadequacies sometimes result.

ANS: D "If individuals experience repeated developmental failures, inadequacies sometimes result" is a true statement. Developmental failures could manifest with ineffective coping skills. However, when an individual experiences successes, health is promoted. Patients have unique patterns of growth and development that are not uniform. Nurses must consider the influence of culture and context on growth and development.

While assessing an 18-month-old toddler, the nurse distinguishes normal from abnormal findings by remembering that Gesell's theory of development states a. "The developmental stage of the toddler is affected solely by environmental influence." b. "Developmental patterns are not affected by gene activity." c. "Skill development should be identical to that of other toddlers in the playroom." d. "Environmental influence does not affect the sequence of development."

ANS: D Gesell's theory of development states that environment plays a part in child development, but it does not have any part in the sequence of development. Other factors influencing growth and development include biological, cognitive, and socioemotional processes. Environmental factors support, change, and modify the pattern of development, but they do not generate progressions of development. Each child's pattern of growth and development is unique and is directed by gene activity. Not every child develops certain skills at the same time. Children grow according to their own genetic blueprint.

The nursing instructor will need to provide further instruction to the student who states a. "Intellectual development is affected by cognitive processes." b. "Socioemotional processes can influence an individual's growth and development." c. "Breast development is an example of a change resulting from biological processes." d. "An individual's biological processes determine physical characteristics and do not affect growth and development."

ANS: D Human growth and development is a complex pattern of movement that involves changes in biological, cognitive, and socioemotional processes. Cognitive processes comprise changes in intelligence, use of language, and development of thinking. Socioemotional processes consist of variations in personality, emotions, and relationships with others. Height and weight, development of gross and fine motor skills, and sexual maturation resulting from hormonal changes during puberty are examples of changes resulting from biological processes.

Which of these approaches would be most appropriate for the nurse to use when teaching a 4-year-old patient about a scheduled surgery? a. Give the parents a book to read about the procedure and do not discuss the procedure with the child to decrease anxiety. b. Set boundaries before teaching by telling the child that she can ask only three questions because time is limited. c. Insist that the parents wait outside the room to ensure privacy of the child. d. Allow the child to touch and hold medical equipment such as thermometers and syringes.

ANS: D Nursing interventions during the preoperational period (age 2 to 7 years) should recognize the use of play (such as handling equipment) to help the child understand the events taking place. Giving the parents a book and not involving the child is not the best option, because the nurse should explain all procedures to children and their parents. Children tend to ask a lot of questions; therefore limiting questions may increase anxiety. Parents and the child all should be involved in preoperative teaching because the parents will be the primary caregivers upon discharge.

Phallic or oedipal (3-6 years)

The genital organs are the focus of pleasure during this stage. The boy becomes interested in the penis, a girl becomes aware of the absence of the penis, known as penis envy. This is a time of exploration and imagination as a child fantasizes about the parent of the opposite sex as his or her first love interest, known as the oedipus or Electra complex. By the end, they now identify with the parent of the same sex

Trust vs mistrust (birth to one year)

The infants successful resolution of this days requires a consistent caregiver who was able to meet his needs. From this basic trust and parents, the infant is able to trust in themselves, or in others, and in the world. The formation of trust results in faith and optimism.

Post conventional level 3

The person find balance between basic human rights and obligations and societal rules and regulations. Individuals move away from our decisions based on a thority or conformity to group to define their own moral values and principles

Formal operations 11 years to adulthood

The transition from concrete to formal operational thinking occurs in stages during which there is a prevalence of egocentric thought. They demonstrate feelings and behaviors characterized by self consciousness , I believe that their actions and the parents are constantly being scrutinized. Who believe that hearts and feelings how you need, and that they are invulnerable which leads to risk taking behaviors.

Preconventional reasoning level 1

Thinking is mostly based on mikes in pleasures. Has punishment guide behavior. Consequences will never be a pharmacist punishment or a reward

Intimacy vs isolation (young adult)

Young adults, having developed a sense of identity, deepen their capacity to love others and care for them. They search for meaningful friendships and intimate relationship with another person. If the young adult is not able to establish companionship and intimacy, isolation results because he or she fears rejection and disappointment

Industry versus inferiority (6 to 11 years)

going to apply themselves to learning socially productive skills & tools. They learn to work and play with their peers. They thrive on their accomplishments and praise. Without proper support for learning new skills or skills are too difficult, they develop a sense of inadequacy and inferiority.