Fundemntals of Nursing Chapter 21

Middle adulthood haighhurst

Accepting and adjusting to physical changes Attaining and maintaining a satisfactory occupational performance Assisting children to become responsible adults Relating to the spouse as a person Adjusting to aging parents Achieving adult social and civic responsibility

Levinson's Theory of Development

Individual life structure Pattern of life formed by three components Self (values and motives) Social and cultural aspects of one's life (family, career, religion, ethnicity) Particular set of roles in which one participates (husband, father, friend, student)

Gould's Theory of Development

Studies men and women between 16 to 60 years of age. Central theme for adult years is "transformation." Specific beliefs and developmental phases.

t/f Levinson and assciates based on their devlopmental theory on the organizing concepts of individual life structure

True

The Superego

mind commonly called the conscience. It develops from the ego during the first year of life, as the child learns praise versus punishment for actions. The superego represents the internalization of rules and values so that socially acceptable behavior is practiced.

Devlopment

orderly pattern of changes in structure, throughs, feelings, or behaviors resulting from maturation, experiences and learning, dynaamic and continous process

The ID

part of the mind concerned with self-gratification by the easiest and quickest available mean

Kohlberg's stages of moral development

preconventional, conventional, postconventional

Four major componets of the Freud Theory

unconscious mind, the ID, the ego and the superego

Principles of Growth and Devlopment

-orderly and sequential -continuous and complex -follow regular and predictable trends are both differentiated and integrated -aspects occur at different stages and rates, and can be modified -the pace is specific for each person

Role of Genetics in Growth and Development

- At conception, every human receives an equal number of chromosomes from each parent. - The characteristics inherited from each parent are carried in gene pairs on the 23 pairs of chromosomes, which carry the genetic information that determines the person's cellular differentiation, growth, and function. - As a result, physical characteristics such as height, bone size, and eye and hair color are inherited from our family of origin. - Genetics also influences the development of many diseases.

Sigmund Freud Theory

"• father of the Psychoanalytic School of Psychology• divided the mind into the conscious, preconscious and unconscious mind• emphasized the way our unconscious thought processes and our emotional responses to childhood experiences affect our behavior• developed how the ego protects itself through the use of defense mechanisms:

Erik Erikson's stages of psychosocial development

(1) Trust vs. Mistrust; (2) Autonomy vs. Shame; (3) Initiative vs. Guilt; (4) Industry vs. Inferiority; (5) Identity vs. Confusion; (6) Intimacy vs. Isolation; (7) Generativity vs. Self-absorption; (8) Integrity vs. Despair.

Factors inluding Growth and devlopment

-genetic history, base -prenatal, individual and caregiver factors -health illness state -culture

sensorimotor stage (birth-2 years)

0 to 1 month: Demonstrates basic reflexes, such as sucking 1 to 4 months: Discovers enjoyment of random behaviors (such as smiling or sucking thumb), and repeats them 4 to 8 months: Relates own behavior to a change in environment, such as shaking a rattle to hear the sound or manipulating a spoon to eat 8 to 12 months: Coordinates more than one thought pattern at a time to reach a goal, such as repeatedly throwing an object on the floor; only objects in sight are considered permanent 12 to 18 months: Recognizes the permanence of objects, even if out of sight; can understand simple commands 18 to 24 months: Begins to develop reasoning and can anticipate events

Later Maturity (Havighurst)

1. Adjusting to decreasing physical strength/health. 2. Adjusting to retirement and reduced income. 3. Adjusting to death of spouse. 4. Establishing an explicit affiliation with peers. 5. Meeting social and civic obligations. 6. Establishing satisfactory physical living arrangements.

Gould's Theory of Development

AGES 18 TO 22 YEARS: LEAVING THE PARENTS' WORLD During the young adult years, individuals typically struggle with leaving their parents' world and challenging false assumptions from their childlike consciousness (e.g., "Only my parents can guarantee my safety."). However, these assumptions may be replaced with new false assumptions, such as, "Rewards will come automatically if I do what I am supposed to do." AGES 22 TO 28 YEARS: GETTING INTO THE ADULT WORLD Individuals in their 20s feel established as adults and separate from their families, but believe they must still demonstrate their competence as independent adults to their parents. They want to enjoy the present, but build for the future. AGES 29 TO 34 YEARS: QUESTIONING AND REEXAMINATION Self-acceptance increases as the person's need to prove his or her competence disappears. Marriage and careers are generally well established, and young parents want to accept their own children for what they are becoming without imposing rules. Questions about life in general are still present. AGES 35 TO 43 YEARS: MIDLIFE DECADE Adults in this age group tend to continually look inward and question themselves, their values, and life. They see time as having an end and believe they have little time left to shape the behavior of their adolescent children (Fig. 21-6). They may be critical of their own parents, blaming them for many of their own problems. AGES 43 TO 50 YEARS: RECONCILIATION AND MELLOWING At this phase, adults accept the reality of boundaries for the lifespan and believe that personalities are set. They are interested in an active social life, church activities, community service, friends, and spouse. Life is viewed as neither simple nor controllable, which may result in periods of passivity, rage, depression, and despair. AGES 50 AND OVER: STABILITY AND ACCEPTANCE Previous patterns of reflection and contemplation generally result in increased self-approval and self-acceptance. Increased marital happiness and contentment are associated with seeing the spouse as a valued companion.

Haighhurst Adolenses

Accepting his or her body and using it effectively Achieving a masculine or feminine gender role Achieving emotional independence from parents and other adults Preparing for a career Preparing for marriage and family life Desiring and achieving socially responsible behavior (see the accompanying Research in Nursing box on page 518) Acquiring an ethical system as a guide to behavior

Haighhurst Infancy and early childhood

Achieving physiologic stability Learning to eat solid foods Learning to walk and talk Forming simple concepts of social and physical reality Learning to relate emotionally to parents, siblings, and other people Learning to control the elimination of body wastes Learning to distinguish between right and wrong Learning sex differences and sexual modesty

Which compondent of Frueds theory is the part of the mind that serves as the mediator between a persons desires and the constraints of reality? a. the unconscious mind b. the ID c. the ego d. the superego

C

According to Havighurst's developmental theory, what would be a task for the adolescent? A. Learning to relate emotionally to parents, siblings, and others B. Developing fundamental skills in reading, writing, and mathematics C. Attaining and maintaining a satisfactory occupational performance D. Desiring and achieving socially responsible behavior

D

Leveins Theory phases

Early Adult Transition The major concerns of the young adult (ages 17 to 22) are to break away from his or her parents, make initial career choices, and establish intimate relationships. Many separations, losses, and transformations are necessary to terminate old relationships. This is also a time to begin to select personal values and establish goals, as the young adult's life structure begins to be more integrated. Entering the Adult World The years of the middle to late 20s (ages 22 to 28) are a time to build on previous decisions and choices, and to try different careers and lifestyles. By the late 20s, the young adult enters the age-30 transition period. The person often feels uneasy that something is missing. During this transition, decisions are made either to find a new direction in life or to make a stronger commitment to previous choices. The Age-30 Transition This represents a transition time (ending around age 33) during which the overriding task of the novice phase—to establish a place in the world and create a viable, suitable life structure—is evaluated. This time of reflection allows for reconsideration of choices and to make changes. SETTLING DOWN: BUILDING A SECOND ADULT LIFE STRUCTURE In the settling-down phase (ages 33 to 40), the adult invests energy into the areas of life that are most personally important. The areas of investment are primarily family, work, and community. The person strives to gain respect, status, and a sense of authority. MIDLIFE TRANSITION AND ENTERING MIDDLE ADULTHOOD Midlife Transition Midlife transition (ages 40 to 45) involves a reappraisal of goals and values. The person's established lifestyle may continue, or he or she may choose to reorganize and change careers. This is an unsettled time, with the person often anxious and fearful. There is a focus on leaving a legacy and how short life is. Entering Middle Adulthood This time (ages 45 to 50) revolves around having made choices and having formed a new life structure, and committing to new tasks.

In fowlers stage 5, conjunctive faith, older adolessents and young adults become responsible for their own commitments, beliefs and attudes t/f

False

Jean Piaget

Four stage theory of cognitive development: 1. sensorimotor, 2. preoperational, 3. concrete operational, and 4. formal operational. He said that the two basic processes work in tandem to achieve cognitive growth-assimilation and accomodation

Oral Stage (0-18 months)

Freud's first stage of psychosexual development during which pleasure is centered in the mouth

Haighhurst Middle Childhood

Learning physical skills necessary for games Learning to get along with age-mates Developing fundamental skills in reading, writing, and mathematics Developing a conscience, morality, and a scale of values Achieving personal independence

Fowler's Theory of Faith Development

Prestage: undifferentiated faith Stage 1: intuitive-projective faith Stage 2: mythical-literal faith Stage 3: synthetic-conventional faith Stage 4: individuative-reflective faith Stage 5: conjunctive faith Stage 6: universalizing faith

Young adulthood haighhurst

Selecting a mate (Fig. 21-5 on page 518) Learning to live with a marriage partner Starting a family and rearing children Managing a home Getting started in an occupation Taking on civic responsibility Finding a congenial social group

Anal Stage (8 months to 3 Years)

This stage begins with the development of neuromuscular control to allow control of the anal sphincter. Toilet training is a crucial issue that requires delayed gratification as the child compromises between enjoyment of bowel function and limits set by social expectations.

Latency Stage (7 to 12 years)

This stage marks the transition to the genital stage during adolescence. Increasing sex-role identification with the parent of the same sex prepares the child for adult roles and relationships.

A 2-year-old grabs a handful of cake from the table and stuffs it in his mouth. According to Freud, what part of the mind is the child satisfying? a. Id b. Superego c. Ego d. Unconscious mind

a

A nurse caring for older adults in a long-term care facility encourages an older adult to reminisce about past life events. This life review, according to Erikson, is demonstrating what developmental stage of the later adult years? a. Ego integrity b. Generativity c. Intimacy d. Initiative

a

A school nurse is studying Kohlberg's theory of moral development to prepare a parent discussion addressing the problem of bullying. According to Kohlberg, which factor initially influences the moral development of children? a. Parent/caregiver-child communications b. Societal rules and regulations c. Social and religious rules d. A person's beliefs and values

a

A nurse researcher studies the effects of genomics on current nursing practice. Which statements identify genetic principles that will challenge nurses to integrate genomics in their research, education, and practice? Select all that apply. a. Genetic tests plus family history tools have the potential to identify people at risk for diseases. b. Pharmacogenetic tests can determine if a patient is likely to have a strong therapeutic response to a drug or suffer adverse reactions from the medication. c. Evidence-based review panels are in place to evaluate the possible risks and benefits related to genetic testing. d. Valid and reliable national data are available to establish baseline measures and track progress toward targets. e. Genetic variation can either accelerate or slow the metabolism of many drugs. f. It is beyond the role of the nurse to answer questions and discuss the impact of genetic findings on health and illness.

a,b,e

The nurse caring for infants in a hospital nursery knows that newborns continue to grow and develop according to individual growth patterns and developmental levels. Which terms describe these patterns? Select all that apply. a. Orderly b. Simple c. Sequential d. Unpredictable e. Differentiated f. Integrated

a,c,e,f

A nurse is teaching parents of preschoolers what type of behavior to expect from their children based on developmental theories. Which statements describe this stage of development? Select all that apply. a. According to Freud, the child is in the phallic stage. b. According to Erikson, the child is in the trust versus mistrust stage. c. According to Havighurst, the child is learning to get along with others. d. According to Fowler, the child imitates religious behavior of others. e. According to Kohlberg, the child defines satisfying acts as right. f. According to Havighurst, the child is achieving gender-specific roles.

a,d,e

preoperational Stage (ages 2 or 3 to 6 or 7 years)

beginning use of symbols, through increased language skills and pictures, to represent the preschooler's world (Fig. 21-2). This stage is divided into two parts: the preconceptual stage (ages 2 to 4 years) and the intuitive stage (ages 4 to 7 years). Play activities during this time help the child understand life events and relationships.

A nurse examining a toddler in a pediatric office documents that the child is in the 90th percentile for height and weight and has blue eyes. These physical characteristics are primarily determined by which of the following? a. Socialization with caregivers b. Maternal nutrition during pregnancy c. Genetic information on chromosomes d. Meeting developmental tasks

c

A nurse is interviewing a 42-year-old patient who is visiting an internist for a blood pressure screening. The patient states: "I'm currently a sales associate, but I'm considering a different career and I'm a little anxious about the process." According to Levinson, what phase of adult life is this patient experiencing? a. Entering the adult world b. Settling down c. Midlife transition d. Entering middle-adulthood

c

A nurse who is working with women in a drop-in shelter studies Carol Gilligan's theory of morality in women to use when planning care. According to Gilligan, what is the motivation for female morality? a. Law and justice b. Obligations and rights c. Response and care d. Order and selfishness

c

Phallic Stage (age 3 to 7 years)

child has increased interest in sex differences and in his or her own sex (Fig. 21-1). The child experiences conflict and resolution of that conflict with the parent of the same sex (named the Oedipus complex in boys and the Electra complex in girls, based on feelings of intimate sexual possessiveness for the opposite-sex parent). Curiosity about the genitals and masturbation increase during this stage

Concrete opertaional Stage (ages 6 or 7 to 11 or 12)

children learn by manipulating concrete or tangible objects and can classify articles according to two or more characteristics. Logical thinking is developing, with an understanding of reversibility, relations between numbers, and loss of egocentricity, in addition to the ability to incorporate another's perspective. Children become increasingly aware of external events, and realize that their feelings and thoughts are unique and may not be the same as those of other children their age

Unconsious Mind

contains memories, motives, fantasies, and fears that are not easily recalled but that directly affect behavior.

The school nurse uses the principles and theories of growth and development when planning programs for high school students. According to Havighurst, what is a developmental task for this age group? a. Finding a congenial social group b. Developing a conscience, morality, and a scale of values c. Achieving personal independence d. Achieving a masculine or feminine gender role

d

Robert J Havighhurst Theory of devlopment

descibred learned behaviors as devlopmental tasks

Epigentics

emerging field of study that is still undergoing definition and refinement a. first appearing in the 1940s, epigenetics is generally defined as the study of teh changes that occur in organisms due to modifcation of gene expression and hereditability, not a change in the DNA sequence

growth

increase in body size or changes in body cell structure functions and complexity

The ego

intelligence, memory, problem solving, separation of reality from fantasy, and incorporation of experiences and learning into future behavior

Gilligan's theory of moral development

level 1: individual survival level 2: care and responsibility for others level 3: balance of care for self and others

genital Stage (12 to 20 years)

sexual interest can be expressed in overt sexual relationships

Formal Operational Stage (age 11 or 12 to 14 or 15 years)

stage is characterized by the use of abstract thinking and deductive reasoning. General concepts are related to specific situations and alternatives are considered. The world is evaluated by testing beliefs in an attempt to establish values and meaning in life.

Eriksons Theory of Psychosocial Devlopment

stages of devlopment devlopmental goals or tasks psychosocial cries the process of coping

Erik Erikson's stages of psychosocial development

stages of devlopment devlopmental goals or tass psychosocail cries process of coping

Genomics

the study of the structure and interactions of all genes in the human body, including their interactions with each other as well as the environment.

Incorporating Principles of Growth and Development

•Know the various stages of cognitive, psychosocial, moral, and spiritual development. •Maintain flexibility in assessing people, and respect the uniqueness of each person. •Anticipate possible regression during difficult periods or times of crisis. •Understand that environmental and cultural influences have a strong effect on development.