Chapter 22: Developmental Concepts

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

The unconscious mind

What is libido?

The underlying stimulus for human behavior as sexuality; the ID

What was Freud's theory?

Theory that emphasizes the effect of instinctual human drives on behavior

Neglect and abuse, mental illness, intellectual disabilities, and severe learning disabilities are all what?

Caregiver factors that can affect development

Who was Roger Gould?

A psychiatrist trained in a psychoanalytic perspective, studied people between the ages of 16 and 60 years. He labeled the central theme for adults transformation and identified specific beliefs and developmental phases.

A parent shares with the nurse in the pediatric clinic that their 12-month-old cries when they leave the room or hide a favorite stuffed animal. The nurse explains that object permanence typically occurs in which group? a. 0 to 6 months b. 12 to 18 months c. 24 to 36 months d. 36 months to 4 years

B Object permanence typically develops at age 12 to 18 months.

Erik Erikson's theory was based on what 4 major organizing concepts?

- Stages of development - Developmental goals or tasks - Psychosocial crises - Process of coping

How many pairs of chromosomes are obtained from each parent?

23 pairs

How many chromosomes do humans have?

46 chromosomes

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

A Freud defined the id as the part of the mind concerned with self-gratification by the easiest and quickest available means.

When caring for older adults in a long-term care facility, a nurse encourages an older adult to talk about past life events. One patient tells the nurse they were an angry person, lost many jobs, and ended up alone. According to Erikson, this patient is in what developmental stage? a. Despair b. Stagnation c. Inferiority d. Industry

A Reminiscence during the older years of a person's life provides a sense of fulfillment and purpose (ego integrity). Generativity versus stagnation is a developmental stage of the middle adult years. Industry versus inferiority states that if a child is not accepted by peers or cannot meet parental expectations, feelings of lack of self-worth may develop.

A school nurse uses Kohlberg's theory of moral development as a basis for a roundtable discussion with parents on bullying. According to Kohlberg, what 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 The beginnings of moral development result from parent/caregiver-child communications during early childhood, as the young child tries to please parents and caregivers. Kohlberg's stages of moral development begin in childhood but may continue developing into adolescence and adulthood. Rules and regulations established by society are eventually challenged and evaluated as a person either accepts societal rules into his or her own internal set of values or rejects them.

Nursing students attending a class on genomics are discussing its use in current nursing practice. Which statements by the students 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 positive therapeutic response to a drug or develop 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 bases exist 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 a nurse's scope of practice to discuss the impact of genetic findings and impact on health and illness.

A, B, E Health care providers are being challenged to integrate genomics into their research, education, and practice. Genetic tests plus family history tools have the potential to identify people at risk for diseases. Pharmacogenetics studies how genetic variation affects a person's response to drugs, helping to determine if a patient is likely to have a strong therapeutic response or develop adverse effects to a drug. Genetic variation can either accelerate or slow the metabolism of many drugs

A nurse caring for newborns understands that babies 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 Growth and development are orderly and sequential as well as continuous and complex. Growth and development follow regular and predictable trends and are both differentiated and integrated.

A nurse is teaching parents of preschoolers the types 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 According to Freud, the child is in the phallic stage. According to Fowler, the child imitates religious behavior of others. According to Kohlberg, the child defines satisfying acts as right. According to Erikson, the child is in the initiative versus guilt stage. According to Havighurst, the child is learning sex differences, forming concepts, and getting ready to read. According to Havighurst, the adolescent, not the preschooler, is achieving gender-specific social roles.

The consideration that smoking (which affects how genomes are expressed in the smoke) may or may not also affect the smoker's offspring is an example of what? A. Epigenomics B. Epigenetics C. Genomics

A. Epigenomics

*Fowler's* Theory of Faith Development Stage 2: Mythic-Literal faith

Accepts existence of deity; strong belief in justice; metaphors and

*Gould Stages:* During the young adult years, individuals typically struggle with leaving their parents' world and challenging false assumptions from their childlike consciousness. 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."

Age 18-22; Leaving the Parent's world

*Gould Stages:* Individuals in their 20s feel established as adults and separate from their families but believe they must still prove to their parents or guardians that they are competent, independent adults. They want to enjoy the present but build for the future.

Ages 22-28; Getting into adult world

*Gould Stages:* Self-acceptance increases as the person's need to prove their 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 unnecessary rules. Questions about life in general are still present.

Ages 29-34; Questioning and reexamination

*Gould Stages:* Adults in this age group tend to continually look inward and question themselves, their values, and their life. They see time as having an end and believe they have little time left to shape the behavior of their adolescent children. They may be critical of their own parents, blaming them for many of their own problems.

Ages 35-43; Midlife decade

*Gould Stages:* 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, 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 43-50; Reconciliation and mellowing

*Gould Stages:* 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.

Ages 50+; Stability and acceptance

*Freud Stages:* Which Psychosocial stage is this? 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. (8 months to 3 years)

Anal stage

*Fowler's* Theory of Faith Development Stage 4: Individuative-relative faith

Angst possible; personal accountability for beliefs and feelings; awareness of conflicts in the complexities of faith

*Erikson Stages:* As motor and language skills develop, the toddler (ages 1 to 3 years) learns from the environment and gains independence through encouragement from caregivers to feed, dress, and toilet themselves. If the caregivers are overprotective or have expectations that are too high, shame, doubt, and feelings of inadequacy may develop in the child.

Autonomy vs Shame/Doubt

*Kohlberg* Moral Development Stage Four: Law and Order

Being good extends to a person's duty to society; aware of need to respect authority

When teaching parents about achievements in children, the nurse explains that, according to Piaget, children in which age group are able to grasp abstract ideas? a. Toddler b. Adolescence c. Preschool age d. School age

C According to Piaget's preoperational stage, increased language, increased understanding of life events, and relationships occur with language greatly increasing from ages 3 to 5 years

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 In Gilligan's theory, men and women have different ways of looking at the world. Women typically see moral requirements emerging from the needs of others within the context of a relationship. This moral orientation of women is called the ethic of care, which develops through three levels: Level 1—Preconventional: Selfishness, Level 2—Conventional: Goodness, Level 3—Postconventional: Nonviolence. Men typically associate morality with obligations, rights, and justice.

While assessing a patient in the medical clinic, the patient tells the nurse: "I'm currently a sales associate, but I'm considering a career move, which makes me somewhat anxious." 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 Midlife transition (ages 40 to 45 years) involves a reappraisal of goals and values. The established lifestyle may continue, or the person may choose to reorganize and change careers, creating anxiety or fear. In the middle to late 20s (ages 22 to 28 years) young adults build on previous decisions and choices and to try different careers and lifestyles. In the settling-down phase (ages 33 to 40 years), the adult invests energy into the areas of life that are most personally important. The years of entering middle adulthood (ages 45 to 50 years) revolve around having made choices and having formed a new life structure, and committing to new tasks.

A nurse assessing a toddler in a pediatric office tells the parents that the child is in the 90th percentile for height and weight and has blue eyes. The nurse explains 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 Physical appearance and growth have a predetermined genetic base in inheritance patterns carried on the chromosomes.

The genetic information carried by chromosomes determines a person's what?

Cellular differentiation, growth, and function.

*Fowler's* Theory of Faith Development Prestage: Undifferentiated faith

Centers on relationship with primary caregiver and the safety of the environment

What is Jean Piaget's theory?

Cognitive development theory; children actively construct knowledge as they manipulate and explore their world

*Piaget Stages:* The stage of cognitive development (from about 6 or 7 to 11 years of age) during which children gain the mental operations that enable them to think logically about concrete events

Concrete operational stage

*Fowler's* Theory of Faith Development Stage 5: Conjunctive faith

Conflicts resolved; identification of truth

A school nurse uses Havighurst's principles and theories of growth and development when planning programs for high school students. With this information, the nurse can assist students to correlate their behavior and decisions to which age-appropriate developmental task? 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 According to Havighurst, the role of the adolescent is to achieve a masculine or feminine gender role. Developing a conscience, morality, and a scale of values and achieving personal independence are roles of middle childhood. Finding a congenial social group is a role of young adulthood.

A nurse working in a hospice setting uses reminiscence to help patients determine whether their life had meaning or if they wish to make amends. What stage of Erickson's development is the nurse applying with this approach? a. Industry versus inferiority b. Initiative versus guilt c. Generativity versus stagnation d. Ego integrity versus despair

D Reminiscence for the older adult provides a sense of fulfillment and purpose (integrity), perhaps removing the fear of dying. A sense of despair may ensue if a person believes that their life has been a series of failures or missed directions. Preschoolers (ages 4 to 6 years) take the initiative in learning and seeking out new experiences; when experiencing restrictions or reprimands, they typically hesitate to attempt more challenging (initiative vs. guilt). The school-aged child enjoys finishing projects and receiving recognition for accomplishments; children who are not accepted by peers or cannot meet parental expectations develop feelings of inferiority and lack of self-worth may develop (industry vs. inferiority). Middle adult years are marked by involvement with family, friends, community, and concern for the next generation; if this task is not met, stagnation occurs, and the person becomes self-absorbed or regresses to an earlier level of coping (generativity vs. stagnation).

*Kohlberg* Moral Development Stage Six: Universal ethical principle

Deeply held moral principles are in accordance with a sense of self and are more important than laws; few adults ever reach this stage of development

*Kohlberg* Moral Development Stage Two: Instrumental relativist

Defines acts satisfying to self (and some satisfying to others) as right

Orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning:

Development

Congenital or genetic disorders, brain damage from accidents or abuse, vision and hearing impairments, chronic illness, inadequate nutrition, chemotherapy or radiation therapy, lead poisoning, poverty, and substance abuse are all factors that can affect what?

Development from birth to adolescence

*Erikson Stages:* Reminiscence about life events provides a sense of fulfillment and purpose. Some older adults may not be fearful of dying if they feel they have achieved integrity. If a person believes their life has been a series of failures or missed opportunities, a sense of despair may prevail. (Later adulthood)

Ego integrity vs Despair

*Fowler's* Theory of Faith Development Stage 6: Universalizing faith

Enlightenment; universality of faith and principles

Poverty, violence, unsafe living conditions, the presence of lead or mold in the home, and the quality of air and water in the surrounding environment are all what?

Environmental factors that influence all stages of development

The study of the changes that occur in organisms due to modification of gene expression and hereditability, not a change in the DNA sequence

Epigenetics

Epigenetic changes that occur in many genes or the entire organism

Epigenomics

*Erikson Stages:* Involvement with family, friends, and community. There is also a tendency to become concerned for the next generation and desire to make a contribution to the world. If this task is not met, stagnation occurs, and the person becomes self-absorbed and obsessed with their own needs, or regresses to an earlier level of coping. (Middle adulthood)

Generativity vs Stagnation

*Fowler's* Theory of Faith Development:

Everyone develops through a shared series of faith structures (or worldviews, broad internal working models, meaning systems) over the course of childhood and adulthood. He believed (like Piaget) the structural stage sequence is sequential, invariant, and hierarchical.

Who is Sigmund Freud?

Father of psychoanalysis

Maternal age (Age of the mother), inadequate prenatal care, inadequate maternal nutrition, and maternal substance use disorder can all affect what?

Fetal development

*Piaget Stages:* The stage of cognitive development (normally beginning about age 12) during which people begin to think logically about abstract concepts

Formal operational stage

*Freud Stages:* Which Psychosocial stage is this? Sexual interest can be expressed in overt sexual relationships. Sexual pressures and conflicts typically cause turmoil as the adolescent makes adjustments in relationships. (12 years to 20 years)

Genital stage

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

Genomics

Increase in body size or changes in body cell structure, function, and complexity:

Growth

Genetics, prenatal, individual, and caregiver factors; and environment and nutrition. health-illness state, and culture all influence the facilitation or delay of what?

Growth and development

*Kohlberg's* Theory of Moral Development

He recognized that a person's moral development is influenced by culture; Developing children progress through a predictable sequence of stages of moral reasoning (preconventional, conventional, postconventional).

*Erikson Stages:* Transition from childhood to adulthood. Hormonal changes produce secondary sex characteristics and mood swings. Trying on roles and even rebellion can be normal behaviors as the adolescent acquires a sense of self and decides what direction to take in life. Role confusion occurs if the adolescent is unable to establish identity and a sense of direction. (Adolescence)

Identity vs Role Confusion

*Fowler's* Theory of Faith Development Stage 1: Intuitive-predictive faith

Imitates religious behaviors of others; learning also occurs th

*Erikson Stages:* Focusing on the end result of achievements, the school-aged child gains pleasure from finishing projects and receiving recognition for accomplishments. If the child is not accepted by peers or cannot meet parental expectations, a feeling of inferiority and lack of self-worth may develop. (School-aged children)

Industry vs Inferiority

*Erikson Stages:* Confidence gained as a toddler allows the preschooler (ages 4 to 6 years) to take the initiative in learning so that the child actively seeks out new experiences and explores the how and why of activities. If the child experiences restrictions or reprimands for seeking new experiences and learning, guilt results, and the child hesitates to attempt more challenging skills in motor or language development. (Preschool)

Initiative vs Guilt

*Erikson Stages:* The tasks for the young adult are to establish close, honest, loving relationships and make commitments to others. Fear of such commitments results in isolation and loneliness. (Young adulthood)

Intimacy vs Isolation

*Freud Stages:* Which Psychosocial stage is this? 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 (7 years to 12 years)

Latency stage

Who's theory centers on the belief that the cycle of life at any point in time is formed by the interaction of three components: the self (values, motives), the social and cultural aspects of the person's life (family, career, religion, racial/ethnic background), and the person's particular set of roles (husband, father, friend, student).

Levinson and associates

What are chromosomes?

Long, thin strings composed of DNA and proteins which carry genes.

*Kohlberg* Moral Development Stage Three: Interpersonal concordance

Morality of maintaining good relations and approval of others; right and wrong are determined by the majority

Who was Erik Erikson?

Most influential neo-Freudian. More emphasis on rational ego, believed development continues through adulthood, more emphasis on social demands.

*Freud Stages:* Which Psychosocial stage is this? Infant uses the mouth as the major source of gratification and exploration. Pleasure is experienced from eating, biting, chewing, and sucking. The infant's primary need is for security. A major conflict occurs with weaning. (Birth to 18 months)

Oral stage

What are the different psychosexual stages? (Sigmund Freud)

Oral stage, anal stage, phallic stage, latency stage, genital stage

Growth and development are ________ and __________, as well as __________ and __________.

Orderly, sequential, continuous, complex

*Kohlberg* Moral Development Stage One: Punishment and Obedience

Oriented to obedience and punishment; right and wrong defined by punishments

What is heredity?

Passing of traits from parents to offspring

*Freud Stages:* Which Psychosocial stage is this? Child has increased interest in sex differences and in their own sex; Child experiences conflict and resolution of that conflict with the parent of the same sex. Curiosity about the genitals and masturbation increases during this stage. (3 years to 7 years)

Phallic stage

*Piaget Stages:* The stage (from about 2 to 6 or 7 years of age) during which a child learns to use language but does not yet comprehend the mental operations of concrete logic

Preoperational stage

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

The superego

*Kohlberg* Moral Development Stage Five: Social Contract

Right and wrong determined by personal values; laws are considered, but may be ignored or discounted

*Fowler's* Theory of Faith Development Stage 3: Synthetic-conventional faith

Selection of principles to follow; development of a personal identity; concern for the rights and needs of others

*Piaget Stages:* The stage (from birth to about 2 years of age) during which infants know the world mostly in terms of their sensory impressions and motor activities

Sensorimotor stage

What are the stages of Cognitive Development?

Sensorimotor, preoperational, concrete operational, formal operational

What are Freud's psychosexual stages of development?

Stages of child development in which a child's pleasure-seeking urges are focused on specific areas of the body called erogenous zones

Conscious part of the mind that serves as a mediator between the desires of the id and the constraints of reality so that a person can live effectively within their social, physical, and psychological environment; includes intelligence, memory, problem solving, separation of reality from fantasy, and incorporation of experiences and learning into future behavior.

The ego

What is a genome?

The entire set of genetic material in an organism

Part of the mind concerned with self-gratification by the easiest and quickest available means. Defense mechanisms are a means of unconscious coping to reduce stress in the conscious mind when impulses cannot be satisfied.

The id

*Erikson Stages:* The infant learns to rely on caregivers to meet basic needs of warmth, food, comfort, and forming trust in others. Mistrust can result from inconsistent, inadequate, or unsafe care. (Infancy)

Trust vs Mistrust

What are the four components of the mind, according to Freud?

Unconscious mind, id, ego, superego