Developmental Concepts Chapter 21 Copyright © 2019 Wolters Kluwer • All Rights Reserved Concepts of Growth and Development Copyright © 2019 Wolters Kluwer • All Rights Reserved Principles of Growth and Development 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 Pace is specific for each person Copyright © 2019 Wolters Kluwer • All Rights Reserved Theories of Development #1 Freud: theory of psychoanalytic development Piaget: theory of cognitive development Erickson: theory of psychosocial development Havighurst: theory based on developmental tasks Gould: theory based on specific beliefs and developmental phases Levinson: theory based on the organizing concepts of individual life structure Copyright © 2019 Wolters Kluwer • All Rights Reserved Theories of Development #2 Kohlberg: theory of moral development Gilligan: conception of morality from the female viewpoint Fowler: theory of faith development Copyright © 2019 Wolters Kluwer • All Rights Reserved Development of a Preschooler Copyright © 2019 Wolters Kluwer • All Rights Reserved Freud’s Theory of Psychoanalytic Development The unconscious mind The id The ego The superego Copyright © 2019 Wolters Kluwer • All Rights Reserved Freud’s Developmental Stages Oral stage (0 to 18 months) Anal stage (8 months to 4 years) Phallic stage (3 to 7 years) Latency stage (7 to 12 years) Genital stage (12 to 20 years) Copyright © 2019 Wolters Kluwer • All Rights Reserved Piaget’s Theory of Cognitive Development Sensorimotor stage (birth to 2 or 3 years) Preoperational stage (2 or 3 to 6 or 7 years) Concrete operational stage (6 to 7 to 11 or 12 years) Formal operational stage (11 or 12 to 14 or 15 years) Copyright © 2019 Wolters Kluwer • All Rights Reserved Erikson’s Theory of Psychosocial Development Stages of development Developmental goals or tasks Psychosocial crises The process of coping Copyright © 2019 Wolters Kluwer • All Rights Reserved Stages of Erikson’s Theory Trust vs. mistrust (infancy) Autonomy vs. shame and doubt (toddler) Initiative vs. guilt (preschool) Industry vs. inferiority (school age) Identity vs. role confusion (adolescence) Intimacy vs. isolation (young adulthood) Generativity vs. stagnation (middle adulthood) Ego integrity vs. despair (later adulthood) Copyright © 2019 Wolters Kluwer • All Rights Reserved Young Adulthood Copyright © 2019 Wolters Kluwer • All Rights Reserved 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) Copyright © 2019 Wolters Kluwer • All Rights Reserved Levinson’s Major Phases in Adulthood Early adult transition Entering the adult world The age thirty transition Settling down Midlife transition Entering middle adulthood Copyright © 2019 Wolters Kluwer • All Rights Reserved Kohlberg’s Stages of Moral Development Preconventional level Conventional level Postconventional level Copyright © 2019 Wolters Kluwer • All Rights Reserved Incorporating Principles of Growth and Development #1 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. Copyright © 2019 Wolters Kluwer • All Rights Reserved Incorporating Principles of Growth and Development #2 Know that within each stage of development, a person may retain behaviors of a previous stage, attain goals of the current stage, and exhibit behaviors of the next stage. Remember that patients are members of families and that the family unit can have both positive and negative influences on the development of individual members. Be ready to provide health care to patients who are ill or who fail to meet developmental goals. Provide environments and experiences that are developmentally challenging. Copyright © 2019 Wolters Kluwer • All Rights Reserved Conception Through Young Adult Chapter 22 Copyright © 2019 Wolters Kluwer • All Rights Reserved Three Stages of the Fetus Pre-embryonic stage: conception to 3rd week Embryonic stage: 4th to 8th week Three distinct cell layers: endoderm, mesoderm, and ectoderm All basic organs established Fetal stage: 9th week to birth Body organs and systems continue to grow Copyright © 2019 Wolters Kluwer • All Rights Reserved Physical Characteristics of a Normal Neonate (Birth to 28 Days) Reflexes develop (moro, stepping, grasp, hand to mouth, sucking, swallowing, blinking, sneezing, yawning.) Body temperature responds quickly to environmental temperature Senses used to respond to environment Stool and urine eliminated Active crying and quiet alert state exhibited Copyright © 2019 Wolters Kluwer • All Rights Reserved Reflexes of the Neonate #1 Copyright © 2019 Wolters Kluwer • All Rights Reserved Reflexes of the Neonate #2 Copyright © 2019 Wolters Kluwer • All Rights Reserved Physiologic Development of the Infant (1 Month to 1 Year) Brain grows to half of adult size. Body temperature stabilizes. Motor abilities develop. Eyes begin to focus and fixate. Heart doubles in weight, heart rate slows, and blood pressure rises. Deciduous teeth begin to erupt at 4 to 6 months. Birth weight usually triples by 1 year (average 22 lb). Copyright © 2019 Wolters Kluwer • All Rights Reserved Psychosocial Development of Infant In oral stage, immediate gratification of needs Develops trust (Erikson) Meets developmental tasks (Havighurst; taking food, walking, talking) Copyright © 2019 Wolters Kluwer • All Rights Reserved Health Care Issues for the Infant Accidental injuries Colic SIDS Failure to thrive Child maltreatment Copyright © 2019 Wolters Kluwer • All Rights Reserved Physiologic Development of Toddler (1 to 3 Years) Rapid brain growth, increase in bone length, and muscle growth Uses fingers to pick up small objects. Walks, runs, kicks, climb, rides tricycle, drinks from cup. Four times birth weight Bladder control during the day, sometimes at night Turns pages in book, and by age 3 draws stick people. Copyright © 2019 Wolters Kluwer • All Rights Reserved Cognitive Development of Toddler In Piaget’s last two stages of sensorimotor development Beginning to understand object permanence Understands self as separate from others Beginning perception of body image Sense of gender identity Language begins; at 2 years, uses short sentences. Copyright © 2019 Wolters Kluwer • All Rights Reserved Psychosocial Development of Toddler Freud: anal stage, toilet training is major focus Erikson: autonomy versus shame and doubt Havighurst: tasks of learning to control elimination process, learn sex differences, form concepts, learn language, and distinguish right from wrong Copyright © 2019 Wolters Kluwer • All Rights Reserved Development in the Toddler Copyright © 2019 Wolters Kluwer • All Rights Reserved Physiologic Development of Preschooler Head is close to adult size by 6 years old. Body is leaner and more coordinated. Motor abilities include jumping, skipping, throwing a ball, printing letters and numbers. Full set of 20 deciduous teeth Average weight 45 pounds Copyright © 2019 Wolters Kluwer • All Rights Reserved Cognitive Development of Preschooler Egocentrism decreases as socialization increases. Play is more related to real-life events. Basic curiosity results in constant questions and improved reasoning ability. Language development is more elaborate. Copyright © 2019 Wolters Kluwer • All Rights Reserved Psychosocial Development of the Preschooler Freud: phallic stage, biologic focus is genital Erikson: initiative versus guilt, conscience develops Havighurst—four developmental tasks Learn sex differences and modesty. Describe social and physical reality in language and concept formation. Get ready to read. Distinguish right from wrong. Copyright © 2019 Wolters Kluwer • All Rights Reserved Physiologic Development of School-Aged Child (6 to 12 Years) Brain reaches 90% to 95% of adult size, nervous system almost mature by age 12. Motor abilities progress to writing in script and in sentences by age 12. Sexual organs grow, but are dormant until late in this period. All permanent teeth present except for 2nd and 3rd molars by age 12. Height increases 2 to 3 inches and weight increases 3 to 6 pounds per year Copyright © 2019 Wolters Kluwer • All Rights Reserved Cognitive Development of School-Aged Child In Piaget’s concrete operational stage, organizing facts and problem solving Uses inductive reasoning to solve new problems. Thinks logically and develops concepts of measurement. Generalizes about people, places, and things. Develops classification systems. Has an awareness of others’ feelings. Understands reversal of events. Copyright © 2019 Wolters Kluwer • All Rights Reserved Psychosocial Development of School-Aged Child Freud: latency stage, strong identification with own sex Erikson: industry versus inferiority stage, focus on learning useful skills, self-identity emerges Havigurst: tasks of learning physical games, appropriate social roles; developing writing, reading, and calculating skills; achieving personal independence; developing conscience, morality, and values Copyright © 2019 Wolters Kluwer • All Rights Reserved Physiologic Development of the Adolescent Feet, hands, and long bones grow rapidly; there is an increase in muscle mass. Primary and secondary development occurs (puberty). Puberty begins at 9 to 13 years in girls, 10 to 14 years in boys. Sebaceous and auxiliary sweat glands become active. Full adult size is usually reached. Copyright © 2019 Wolters Kluwer • All Rights Reserved Three Stages of Puberty Prepubescence Secondary sex characteristics begin to develop. Reproductive organs do not function yet. Pubescence Secondary sex characteristics continue to develop. Ova and sperm begin to be produced. Postpubescence Reproductive functioning and development of secondary sex characteristics reach adult maturity. Copyright © 2019 Wolters Kluwer • All Rights Reserved Cognitive Development of Adolescent/Young Adult Piaget: formal operations Deductive, reflective, and hypothetical reasoning are possible. Abstract concepts can be used. Long-term goals can be set. Concepts of time, its passage, and future become real. Copyright © 2019 Wolters Kluwer • All Rights Reserved Psychosocial Development of Adolescent/Young Adult Freud: genital stage, capable of full sexual function Erikson: identity versus role confusion; self-concept is stabilized; peer group has most influence Havighurst: masculine or feminine social role developed; set of values and ethical system internalized Levinson: early adult transition—making initial career choices, establishing personal relationships, and selecting personal values and lifestyles Gould: theory of transformation—young adults establish their own control as adults separate from family Copyright © 2019 Wolters Kluwer • All Rights Reserved Development in the Adolescent Copyright © 2019 Wolters Kluwer • All Rights Reserved Health Issues for Adolescents/Young Adults Injuries Substance abuse Suicide Pregnancy Nutritional problems Sexually transmitted infections Developmental and situational stressors Copyright © 2019 Wolters Kluwer • All Rights Reserved The Aging Adult Chapter 23 Copyright © 2019 Wolters Kluwer • All Rights Reserved Development of the Middle Adult Physiologic: gradual internal and external physiologic changes occur Cognitive: little change from young adulthood Psychosocial: time of increased personal freedom, economic stability, and social relationships Copyright © 2019 Wolters Kluwer • All Rights Reserved Developmental Tasks of Middle Adulthood Accept and adjust to physical changes. Maintain a satisfactory occupation. Assist children to become responsible adults. Adjust to aging parents. Relate to one’s spouse or partner as a person. Copyright © 2019 Wolters Kluwer • All Rights Reserved Middle Adult Years Copyright © 2019 Wolters Kluwer • All Rights Reserved Leading Causes of Death in Middle Adulthood Malignant neoplasms Cardiovascular disease Unintentional injury including poisoning, motor vehicle accidents, and falls Diabetes mellitus Chronic lower respiratory disease Cerebrovascular causes Copyright © 2019 Wolters Kluwer • All Rights Reserved Common Myths of the Older Adults (Ageism) Old age begins at 65 years. Most older adults are in long-term care facilities. Older adults are sick, and mental deterioration occurs. Older adults are not interested in sex. Older adults do not care how they look and are lonely. Bladder problems are a problem of aging. Older adults do not deserve aggressive treatment for illnesses. Older adults cannot learn new things. Copyright © 2019 Wolters Kluwer • All Rights Reserved Moral and Spiritual Development of Older Adults Many adults demonstrate conjunctive faith and trust in a greater power. Self-transcendence is characteristic of later life. Gerotranscendence: describes the transformation of a person’s view of reality from a rational, social, individually focused, materialistic perspective to a more transcendent vision. Copyright © 2019 Wolters Kluwer • All Rights Reserved Basis for Teaching Plan for Older Adults Aging is a normal process, and chronic illness is a pathologic process, but both often occur at the same time . Meeting expenses of health care is often difficult. Medication costs, hospitalization costs, and costs of special equipment and supplies Family members must learn to cope with needs of the ill person. Family members must adapt to psychological stressors. Copyright © 2019 Wolters Kluwer • All Rights Reserved Causes of Accidental Injuries in Older Adults Changes in vision and hearing Loss of mass and strength of muscles Slower reflexes and reaction time Decreased sensory ability Combined effects of chronic illness and medications Economic factors Copyright © 2019 Wolters Kluwer • All Rights Reserved Mental Impairment in Older Adults Dementia Alzheimer disease Sundowning syndrome Cascade iatrogenesis https://www.youtube.com/watch?v=VdzKXhyv_tg Copyright © 2019 Wolters Kluwer • All Rights Reserved Assessment Tool: SPICES S – Sleep disorders P – Problems with eating or feeding I – Incontinence C – Confusion E – Evidence of falls S – Skin breakdown (Fulmer & Wallace, 2012) Copyright © 2019 Wolters Kluwer • All Rights Reserved Elder Abuse Based on recent studies, it is estimated that 10% of adults aged 60 or older who live in the community are abused (Lachs & Pillemer, 2015). Victims are more likely to be women, young-old, lower income, or isolated, with a lack of social support (Lachs & Pillemer, 2015). Elder abuse includes physical abuse, sexual abuse, psychological or emotional abuse, financial abuse or exploitation, and neglect (Hall, Karch, & Crosby, 2016). Copyright © 2019 Wolters Kluwer • All Rights Reserved
