Mental Health Nursing I

Mental Health Nursing I
Lecture Notes
Unit III: Review Developmental Stages Throughout the Lifespan
Objective 1: Review concepts specific to health and development.
Health is the level of functional and metabolic efficiency of an organism. It involves the organism’s ability
to efficiently respond to stressors and effectively restore and sustain homeostasis (Wikipedia, 2007).
Growth refers to the measurable aspect of a person’s increase in physical dimensions. These include
such things as changes in height, weight, teeth and skeletal structures, and sexual characteristics.
Development is a term that refers to behavioral changes and increasing competency in functional
abilities and skills. Behaviors that indicate development are increased ability to function, such as learning
to walk and talk. Chronological age and developmental age are not synonymous. The sequence of
development is predictable even though the emergence of specific skills varies with each person.
Maturation is the biological plan for growth and development. This term describes an increasing
complexity of developmental capabilities that may come with age. Examples of age-related behaviors
that follow a specific sequence are sitting, walking, and reading.
Objective 2: Review Erikson’s eight stages of development and describe how mastery of each task
relates to one’s self concept.
Erikson (1963) developed his theory of psychosocial development based on the influence of social
processes on the development of the personality. He identified eight stages of development and the
major tasks associated with each:
 Stage 1 – Trust vs. Mistrust, birth to 18 months: Develop a sense of trust in others.
 Stage 2 – Autonomy vs. Shame and Doubt, 18 months to 3 years: Learn self-control.
 Stage 3 – Initiative vs. Guilt, 3-6 years: Initiate spontaneous activities.
 Stage 4 – Industry vs. Inferiority, 6-12 years: Develop necessary social skills.
 Stage 5 – Identity vs. Role Confusion, 12-20 years: Integrate childhood experiences into a personal
 Stage 6 – Intimacy vs. Isolation, 18-25 years: Develop commitments to others and to a career.
 Stage 7 – Generativity vs. Stagnation, 21-45 years: Establish a family and become productive.
 Stage 8 – Integrity vs. Despair, 45+ years: View one’s life as meaningful and fulfilling.
Objective 3: Describe the major developmental characteristics and concerns of each of the eight stages.
Wikipedia (2007) –
Infancy (Stage 1), Trust vs. Mistrust, birth to 18 months
 social attachment; maturation of sensory, perceptual, and motor functions
 development of trust in the mothering figure and ability to generalize it to others
 failure = emotional dissatisfaction with self and others, suspiciousness, and difficulty with
interpersonal relationships
Younger Years (Stage 2), Autonomy vs. Shame and Doubt, 18 months to 3 years
 self-control; language development; fantasy play
 gaining independence within the environment
 failure = lack of self-confidence, lack of pride in the ability to perform, a sense of being controlled by
others, and rage against self
Early Childhood (Stage 3), Initiative vs. Guilt, 3 to 6 years
 early moral development; self-esteem; group play; egocentrism
 development of a sense of purpose and the ability to initiate and direct own activities
 failure = feelings of inadequacy and guilt and the accepting of liability in situations for which he/she is
not responsible
Middle Childhood (Stage 4), Industry vs. Inferiority, 6 to 12 years
 friendship; skill learning; self-evaluation; team-play
 achievement of a sense of self-confidence by learning, competing, performing successfully, and
receiving recognition from significant others, peers, and acquaintances
 failure = difficulty in interpersonal relationships caused by feelings of inadequacy
Adolescence (Stage 5), Identity vs. Role Confusion, 12 to 20 years
 physical maturation; emotional development; membership in peer group; sexual relationships
 integration of tasks mastered in previous stages into a secure sense of self
 failure = self-consciousness, doubt, and confusion about one’s role in life
Early Adulthood (Stage 6), Intimacy vs. Isolation, 18 to 25 years
 stable relationships; child-bearing; work
 formation of an intense, lasting relationship of a commitment to another person, a cause, an
institution, or a creative effort
 failure = withdrawal, social isolation, aloneness, and the inability to form lasting, intimate relationships
Middle Adulthood (Stage 7), Generativity vs. Stagnation, 21 to 45 years
 nurture close relationships; management of career and household; parenting
 achievement of life goals established for oneself while also considering the welfare of future
 failure = lack of concern for the welfare of others and total preoccupation with the self
Late Adulthood (Stage 8), Integrity vs. Despair, 45+ years
 promote intellectual vigor; redirect energy to new roles and activities; develop a point-of-view about
 review of one’s life and assignment of meaning from both positive and negative events; achieving a
positive sense of self-worth
 failure = self-contempt and disgust with how life has progressed
Objective 4: Describe the basic human needs in each level of Maslow’s Hierarchy of Needs.
Refer to Maslow’s Hierarchy of Needs PowerPoint
Objective 5: List the factors which influence the client’s ability to meet physiological and safety needs.
Age – infants and young children, the frail elderly
Cultural beliefs – affect attitudes toward health and illness
Spirituality – may be an asset or a liability to the patient’s ability to cope with illness
Self-concept – refers to the notions, beliefs, and convictions persons hold about themselves; patients’
perception of these changes and their ability or inability to cope with the changes may result in stress,
fear, and anxiety
Family/community resources – because of increasing stresses on the family unit, many families are
not able to provide as much support as the patient may need; many of the functions once provided by
families are being assumed by social institutions within the community
Emotional responses to illness – coping methods utilized by patients and families may become
maladaptive in the face of stress and fear; ineffective coping may evolve from a sense of
helplessness or powerlessness
Objective 6: Describe nursing measures that will assist the client in meeting physiological and safety
Appropriate nursing diagnoses for clients with compromised ability to meet physiological needs:
 Ineffective airway clearance
 Risk for aspiration
 Ineffective breathing pattern
 Altered nutrition, less (or more) than body requirements
 Constipation or Diarrhea
 Total urinary incontinence
 Fluid volume deficit
 Impaired mobility
 Sleep pattern disturbance
 Pain
 Impaired skin integrity
Appropriate nursing diagnoses for clients with compromised ability to meet safety needs:
 Risk for falls/injury/infection
 Anxiety or Fear
 Memory impairment
 Confusion
Objective 7: Discuss priority needs of the client.
The lower needs in Maslow’s Hierarchy of Needs must be fulfilled before those at higher levels can be
achieved. The basic needs for human functioning are the physiological needs, and safety and security
needs (Wikipedia, 2007).
Objective 8: Relate how self-esteem can affect the hospitalized individual.
Hospitalization takes away the individual’s locus of control, which highly impacts self-esteem (Goodman,
S. H., Cooley, E. L., Sewell, D. R., & Leavitt, N., 1994, Locus of control and self-esteem in depressed,
low-income African-American women, Community Mental Health Journal, 30(3).