Chapter 11: Developmental Theories
Developmental Theories
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Biophysical Developmental Theories
o Biophysical development
 Is how our physical bodies grow and change
o Gesell’s Theory of Development
 Is that each child’s pattern of growth is unique and this pattern is directed
by gene activity
 Cephalocaudal pattern
 Describes the sequence in which growth is fastest a the top
 Ex: head and brain develop faster than arm and leg coordination
 Proximodistal growth pattern
 Starts at the center of the body and move toward the extremities
 Ex: organ systems in the trunk of the body develop before the arms
and legs
Psychoanalytical/Psychosocial Theory
o Sigmund Freud
 Freud’s psychoanalytical model of personality development
 States that individuals go through 5 stages of psychosexual
development and that each stage is characterized by sexual
pleasure in parts of the body: the mouth, the anus, and the genitals
 Stage 1: Oral (Birth to 12 to 18 Months)
 Sucking and oral satisfaction are not only vital of life but also
pleasurable
 Stage 2: Anal (12 to 18 Months to 3 Years)
 Children become increasing aware of the pleasurable sensation of
this body region with interest in the products of their effort.
 Stage 3: Phallic or Oedipal ( 3 to 6 Years)
 The genital organs become the focus of pleasure
 Penis envy
o the absence of the penis
 Oedipus or Electra complex
o 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
 Stage 4: Latency (6 to 12 years)
 Sexual urges are repressed and channeled into productive activities
that are socially acceptable
 Stage 5: Genital (Puberty Through Adulthood)
 Earlier sexual urges reawaken and are directed to an individual
outside the family circle
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Id
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Most primitive part of the personality and originates in the
infant
Ex: basic instinctual impulses driven to achieve pleasure
Ego
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Represents the reality component, mediating conflicts
between the environment and the focus of the id
o Helps people judge reality accurately, regulate impulses,
and make good decisions
o One’s sense of self
Superego
o Performs regulating, restraining, and prohibiting actions.
o Referred to as conscience,
o Influenced by the standards of outside social forces (Ex:
parent or teacher)
Erik Erikson
 Trust vs. Mistrust (Birth to 12 to 18 months)
 Sensorimotor period
 Establishing a basic sense of trust is essential for the development
of a healthy personality
 Instant caregiver (parents) that available that meet their needs
 Result in faith and optimism
 Autonomy vs Sense of Shame and Doubt (18 Months to 3 Years)
 Preoperational period
 More accomplished in some basic self-care activities, including
walking, feeding and toileting.
 Result of maturation and imitation
 A toddler who successfully masters this stage achieves self-control
and willpower
 Provides many choices for them to choose
 Initiative vs Guilt ( 3 to 6 Years)
 Use of symbols, egocentric
 Children like to pretend and try out new roles
 Fantasy and imagination allow them to further explore their
environment
 Developing superego or conscience
 Preschoolers learn to maintain a sense of initiative without
imposing on the freedoms of others
o Frequently engage in animism, a developmental
characteristic that makes them treat dolls or stuffed animals
as if they have thoughts and feelings.
 Play therapy is also instrumental in helping a child successfully deal
with the inherent threats related to hospitalization or chronic
illness.
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Caregiver should not respond to harsh to prevent children to feel
guilt.
Industry vs Inferiority (6 to 12 Years)
 Concrete operations period
 School age children are eager to apply themselves to learning
socially productive skills and tools
 Learn to work and play with their peers
 During hospitalization it is important for a school-age child to
understand the routines and participate, when possible, in his or
her treatment.
 Ex: some children enjoy keeping a record of heir intake and output
Identity vs. Role Confusion (Puberty)
 Formal operations period
 Physiological changes associated with sexual maturation mark this
stage.
 Marked preoccupation with appearance with appearance and body
image.
 “Who Am I?”
 New social demands, opportunities, and conflict that relate to the
emergent identity and separation from family.
 When adolescents are hospitalized, help them deal with their illness
by giving them enough information to help more decisions about
their treatment plan.
Intimacy vs. Isolation (Young Adult)
 Develops a sense of identity, deepen their capacity to love others
and care for them
 Search for meaningful friendships and an intimate relationship with
another person.
 Intimacy as finding the self and then losing it in another
 During hospitalization a young adult’s need for intimacy remains
present; thus young adults benefits from the support of their
partner or significant other during this time.
Generativity vs. Self -Absorption and Stagnation (Middle Age)
 Focuses on supporting future generations
 Ability to expand one’s personal and social involvement is critical
 Middle age adults achieve success in this stage by contributing to
future generations through parenthood, teaching, mentoring, and
community involvement
 Stagnation
o Inability to play role in the development of the next
generation
 Find a sense of fulfillment by volunteering in a local school, hospital,
or church
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Integrity vs. Despair (Old Age)
 Review their lives with a sense of satisfaction, even with their
inevitable mistakes
 Others see themselves as failure, with their lives marked by despair
and regret
 Engage in retrospective appraisal of their lives
 Interpret their lives as a meaningful whole of experience regret
because of goals not achieved
 Aging process creates physical and social losses, some adults also
suffer loss of status and function (ex: through retirement or illness)
 Encouraging older adults to reflect on their meaningful
relationships, such as relationships with a high power, family
members, or the community
o Theories Related to Temperament
 Temperament
 A behavioral style that affects an individual’s emotional interactions
with others.
 Temperamental Traits
 Easy Child
o Easygoing and even tempered
o Regular and predictable in his or her habits
o Open and adaptable to change and displays a mild to
moderately intense mood that is typically positive
 Slow and warm up child
o Displays discomfort when introduced to new situations and
needs time to adjust to new environment, authority figures,
and expectations.
o Respond with tears, somatic complaints, or other
maneuvers to avoid the situation
o Ex: complaining of a stomachache to avoid going to school
 Difficult child
o Highly distracted, active ,irritable, and irregular in habits
o Benefits from “practice” or role playing to be successful
with new skills, situations, or environments
Perspectives on Adult Development
Cognitive Developmental Theory
o Jean Piaget
 Was interested in the development of children’s intellectual organization:
how they think, reason, and perceive the world
o Piaget’s theory of cognitive development
 Includes 4 periods that are related to age and demonstrate specific
categories of knowing and understanding.
 Period I: Sensorimotor (Birth to 2 Years)
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Develop a schema or action pattern for dealing with the
environment
 Schemas include hitting, looking, grasping, or kicking
 Ex: Infant learning that sucking achieves a pleasing result
generalizes the action to suck fingers, blanket, or clothing)
 Object permanence
o This understanding that objects continue to exist even they
cannot be seen, heard, or touched and considered it one of
the child’s most important accomplishments
 He or she learns that he or she is separate from the environment
and that aspects of the environment (parents or fav toys) continue
to exist even though they cannot always be seen.
Period II: Preoperational (2 to 7 Years)
 Children learn to think with the use of symbols and mental images
 “Egocentrism: in that they see objects and people from only one
point of view, their own
 Play becomes a primary means by which they foster their cognitive
development and learn about the world
 Play therapy is nursing intervention that helps the child work
through invasive and intrusive procedures that may occur during
hospitalization
Period III: Concrete Operations (7 to 11 Years)
 Able to perform mental operations
 Ex: child thinks about an action that before was performed
physically
 Able to describe a process without actually doing it
 Seriation
o Ability to mentally classify objects according to heir
quantitative dimensions is achieved
o Able to correctly order to sort objects by length, weight, or
other characteristics
 Conservation
o Ability to see objects or quantities as remaining the same
despite a change in their physical appearance.
Period IV: Formal Operations (11 Years to Adulthood)
 Demonstrate feelings and behaviors characterized by selfconsciousness: a belief that their actions and appearance are
constantly being scrutinized (an “imaginary audience”), that their
thoughts and feelings are unique (the “personal fable”), and that
hey are invulnerable.
 Feelings of invulnerability frequently lead to risk taking behaviors,
especially in early adolescent.
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Adolescent share experiences with peers, they learn that many of
their thoughts and feelings are shared by almost everyone, helping
them to know that they are not so different
 Have the capacity to reason with respect to possibilities
o Research in Adult Cognitive Development
Moral Developmental Theory
o Kohlberg’s Theory of Moral Development
 Kohlberg’s Theory of Moral Development
 Interviewed children, adolescents, and eventually adult’s and found
that moral reasoning develops in stages
 Children under 4 cannot understand morality
 Level I: Preconventional Reasoning
 The person reflects on moral reasoning based on personal gain
 There is limited cognitive thinking and an individual’s thinking is
primarily egocentric
 Mostly based on likes and pleasure
 Stage 1: Punishment and Obedience Orientation
o In terms of absolute obedience to authority and rules
o “I must follow the rules, otherwise I will be punished.”
o Physical consequences guide right and wrong choices
o If the child is caught, it must be wrong; if they escape, it
must be right
 Stage 2: Instrumental Relativist Orientation
o More than one right view
o The decision to do something morally right is based on
satisfying one’s own needs and occasionally the needs of
others
o Children at this stage follow their parent’s rule about being
home in time for supper because they do not want to be
confined to their room for the rest of the evening if they are
late
 Level II: Conventional Reasoning
 Sees moral reasoning based on his or her own personal
internalization of societal and other’s expectations
 “What’s in it for me?”
 “How ill it affect my relationships with others?”
 Stage 3: Good Boy – Nice Girl Orientation
o Good motives, showing concern for others, and keeping
mutual relationship through trust, loyalty, respect and
gratitude
o the individual wants to win approval and maintain the
expectations of one’s immediate group
o Ex: a person is this stage stays after school and does odd
jobs to win the teacher’s approval
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Stage 4: Society – Maintaining Orientation
o Expand their focus from a relationship with others to
societal concerns.
o Right’s behavior is doing one’s duty, showing respect for
authority and maintaining the social order.
o Ex: Adolescents choose not to attend a party then they
know beer will be served, not because they are afraid of
getting caught but because they know it is not right.
 Level III: Postconventional Reasoning
 Balance between human rights and obligations and societal rules
and regulations
 Stage 5: Social Contract Orientation
o Follows the societal law but recognize the possibility of
changing the law to improve society
o Individuals at this stage make more of an independent
effort to determine what society should value rather than
what the society as a group would value
 Stage 6: Universal Ethical Principles Orientation
o Right by the decision of conscience in accord with selfchosen ethical principles
o These principles are abstract, like the Golden Rule, and
appeal to logical comprehensiveness, universality, and
consistency
o Ex: Martin Luther King believed that although we need laws
and democratic processes, people who are committed to
justice have an obligation to disobey unjust laws and accept
the penalties for disobeying these laws.
Kohlberg’s Critics
 Raise questions about his choice of research subjects
 Constructed a systemized way of looking at moral development and is
recognized as a leader in moral developmental theory.
Moral Reasoning and Nursing Practice