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Theories of personality development and its relevance to nursing practice

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provides a brief idea about various theories regarding personality development

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Theories of personality development and its relevance to nursing practice

  1. 1. Theories of Personality Development and relevance to nursing practice AashishParihar Lecturer CollegeofNursing AIIMS,Jodhpur
  2. 2. Theories of Personality Development and relevance to nursing practice Content- • Psychoanalytic Theory- Freud’s • Interpersonal Theory-Sullivan’s • Theory of Psychosocial Development-Erikson’s • Theory of object relations • Cognitive Development Theory • Theory of Moral Development • A Nursing Model - Hildegard E. Peplau
  3. 3. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s • Built on Freudian theory, it is known as psychosocial development and emphasizes a healthy personality as opposed to a pathologic approach. • Each psychosocial stage has two components—the favorable and the unfavorable aspects of the core conflict—and progress to the next stage depends on resolution of this conflict. • No core conflict is ever mastered completely but remains a recurrent problem throughout life. No life situation is ever secure • Erikson’s life-span approach to personality development consists of eight stages. • Influence of social processes on the development of the personality • Specific tasks associated with each stage must be completed for resolution of the crisis and for emotional growth to occur
  4. 4. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s
  5. 5. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Trust vs. Mistrust (0-1 year) • The first and most important attribute to develop for a healthy personality is basic trust. • Corresponding to Freud’s oral stage, it is a time of “getting” and “taking in” through all the senses. • It exists only in relation to something or someone; therefore, consistent, loving care by a mothering person is essential for development of trust • During the first year, babies depend on others for food, warmth and affection. • They need to be able to blindly trust that they will receive these things fro m their parents or caregivers. • If needs are met consistently, infants will develop a secure attachment with parents and will learn to trust environmental in general. • basic trust in parents stems trust in the world, other people, and oneself. • The result is faith and optimism.
  6. 6. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Trust vs. Mistrust (0-1 year) • Mistrust develops when trust-promoting experiences are deficient or lacking or when basic needs are inconsistently or inadequately met. • If needs of babies are not met responsibly, infant will develop mistrust towards people, environment and even themselves and view world as a dangerous and unreliable place.
  7. 7. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Trust vs. Mistrust (0-1 year) Achievement and Nonachievement of Task • Achievement of the task results in self-confidence, optimism, faith in the gratification of needs and desires, and hope for the future. • Nonachievement results in emotional dissatisfaction with the self and others, suspiciousness, and difficulty with interpersonal relationships.
  8. 8. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Autonomy vs. Shame and Doubt(1-3 year) • Corresponding to Freud’s anal stage, the problem of autonomy can be symbolized by the holding on and letting go of the sphincter muscles • The development of autonomy during the toddler period is centered on children’s increasing ability to control their bodies, themselves, and their environment. • They want to do things for themselves using their newly acquired motor skills of walking, climbing, and manipulating and their mental powers of selecting and decision making. • Much of their learning is acquired by imitating the activities and behavior of others. • Here a toddler tries to control their own bodies by toilet training and their environment, by saying “NO” • The goal of this stage to gain courage and independence while minimizing shame and doubt.
  9. 9. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Autonomy vs. Shame and Doubt(1-3 year) • Negative feelings of doubt and shame arise when children are made to feel small and self-conscious, when their choices are disastrous, when others shame them, or when they are forced to be dependent in areas in which they are capable of assuming control. • Overprotective or ridiculing parents may cause children to doubt abilities and feel shameful about their actions.
  10. 10. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Autonomy vs. Shame and Doubt(1-3 year) Achievement and Nonachievement of Task • Achievement of the task results in a sense of self-control and the ability to delay gratification, as well as a feeling of self- confidence in one’s ability to perform. Autonomy is achieved when parents encourage and provide opportunities for independent activities. • Nonachievement results in a lack of self- confidence, a lack of pride in the ability to perform, a sense of being controlled by others, and a rage against the self. The task remains unresolved when primary caregivers restrict independent behaviors, both physically and verbally, or set the child up for failure with unrealistic expectations.
  11. 11. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Initiative vs. Guilt (3-5 year) • The stage of initiative corresponds to Freud’s phallic stage and is characterized by vigorous, intrusive behavior; enterprise; and a strong imagination. • Children explore the physical world with all their senses and powers. • Children at this stage are eager to tackle new tasks and join in activities with peers, while also developing conscience • Through play children practice new skill and cooperating to achieve common goal • The child forms a superego by identifying with the same sex parent and adopting the society’s moral and gender role standards. • Here the key word in a child’s life changes from “NO” to “WHY”.
  12. 12. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Initiative vs. Guilt (3-5 year) • Children sometimes undertake goals or activities that are in conflict with those of parents or others, and being made to feel that their activities or imaginings are bad produces a sense of guilt • Parents who discourage children’s efforts towards initiative make contribute toward child’s feelings of guilt and may negatively impact their self concept.
  13. 13. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Initiative vs. Guilt (3-5 year) Achievement and Nonachievement of Task • Achievement of the task results in the ability to exercise restraint and self-control of inappropriate social behaviors. Assertiveness and dependability increase, and the child enjoys learning and personal achievement. The conscience develops, thereby controlling the impulsive behaviors of the id. • Nonachievement results in feelings of inadequacy and a sense of defeat. Guilt is experienced to an excessive degree, even to the point of accepting liability in situations for which one is not responsible. The child may view him- or herself as evil and deserving of punishment.
  14. 14. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Industry vs. Inferiority (6-12 year) • The stage of industry is the latency period of Freud • children are ready to be workers and producers. • They want to engage in tasks and activities that they can carry through to completion; they need and want real achievement. • Children learn to compete and cooperate with others, and they learn the rules. • It is a decisive period in their social relationships with others. • The ego quality developed from a sense of industry is competence.
  15. 15. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Industry vs. Inferiority (6-12 year) • Feelings of inadequacy and inferiority may develop if too much is expected of them or if they believe that they cannot measure up to the standards set for them by others. • Too much criticism of a child’s work at this stage can lead to long term feeling of inferiority.
  16. 16. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Industry vs. Inferiority (6-12 year) Achievement and Nonachievement of Task • Achievement of the task results in a sense of satisfaction and pleasure in the interaction and involvement with others. The individual masters reliable work habits and develops attitudes of trustworthiness. He or she is conscientious, feels pride in achievement, and enjoys play, but desires a balance between fantasy and “real-world” activities. Industry is achieved when encouragement is given to performance of activities and responsibilities in the school and community, as well as those within the home, and recognition is given for accomplishments. • Nonachievement results in difficulty in interpersonal relationships because of feelings of personal inadequacy. The individual can neither cooperate and compromise with others in group activities nor problem solve or complete tasks successfully. He or she may become either passive and meek or overly aggressive to cover up for feelings of inadequacy. If this occurs, the individual may manipulate or violate the rights of others to satisfy his or her own needs or desires; he or she may become a “workaholic” with unrealistic expectations for personal achievement.
  17. 17. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Identity vs. Role confusion(13-20 year) • Corresponding to Freud’s genital period, the development of identity is characterized by rapid and marked physical changes. • Children become overly preoccupied with the way they appear in the eyes of others compared with their own self-concept. • Adolescents struggle to fit the roles they have played and those they hope to play with the current roles and fashions adopted by their peers, to integrate their concepts and values with those of society, and to come to a decision regarding an occupation. • Adolescents selectively accept or reject the many different aspects of herself/himself and forms a more coherent and integrated sense of identity. • Adolescents must achieve an identity in occupation, gender roles, politics and religion. • An inability to solve the core conflict results in role confusion. The outcome of successful mastery is devotion and fidelity to others and to values and ideologies.
  18. 18. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Identity vs. Role confusion(13-20 year) • An inability to solve the core conflict results in role confusion. The outcome of successful mastery is devotion and fidelity to others and to values and ideologies. • Lack of direction and self definition • Earlier Psychosocial conflicts not resolved. • Society restricts choices • Unprepared for challenges in life.
  19. 19. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Identity vs. Role confusion(13-20 year) Achievement and Nonachievement of Task • Achievement of the task results in a sense of confidence, emotional stability, and a view of the self as a unique individual. Commitments are made to a value system, to the choice for a career, and to relationships with members of both genders. • Nonachievement results in a sense of self-consciousness, doubt, and confusion about one’s role in life. Personal values or goals for one’s life are absent. Commitments to relationships with others are nonexistent or superficial and brief. A lack of self-confidence is often expressed by delinquent and rebellious behavior. Entering adulthood, with its accompanying responsibilities, may be an underlying fear.
  20. 20. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Intimacy vs. Isolation(20-30 year) • Develop a relationship and joint identity with a partner. • The important event is parenting and the important relationship are lovers, friends and work connections. • In this stage individual must develop intimate relationships through work and social life. • Intimacy is achieved when an individual has developed the capacity for giving of oneself to another. This is learned when one has been the recipient of this type of giving within the family unit.
  21. 21. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Intimacy vs. Isolation(20-30 year) • Inability to establish intimacy leads to social isolation. • Failure to make such connection can lead to promiscuity, exclusivity and isolation. • The task remains unresolved when love in the home has been denied or distorted during the younger years. One fails to achieve the ability to give of the self without having been the recipient of such giving early on from primary caregivers.
  22. 22. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Intimacy vs. Isolation(20-30 year) Achievement and Nonachievement of Task • Achievement of the task results in the capacity for mutual love and respect between two people and the ability of an individual to pledge a total commitment to another. The intimacy goes far beyond the sexual contact between two people. It describes a commitment in which personal sacrifices are made for another, whether it be another person, or if one chooses, a career or other type of cause or endeavor to which an individual elects to devote his or her life. • Nonachievement results in withdrawal, social isolation, and aloneness. The individual is unable to form lasting, intimate relationships, often seeking intimacy through numerous superficial sexual contacts. No career is established; he or she may have a history of occupational changes
  23. 23. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Generativity vs. Stagnation(30-65 year) • Contributing to the next generation by performing meaningful work, creative activities, and raising a family. • Important event is parenting and the important relationships are children and the community. • Generativity encompasses adult’s desire to leave a legacy to the next generation. • Through generativity adults promote and guide those who follow by parenting, teaching, leading, doing things to benefit the community.
  24. 24. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Generativity vs. Stagnation(30-65 year) • Stagnation or self absorption develops when individuals sense that they have done nothing for the next generation. • Simply focusing on oneself is viewed as limited in terms of fulfillment. • A feeling that arises when a person is self centered and unable to help society, a dissatisfaction with the relative and lack of productivity.
  25. 25. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Generativity vs. Stagnation(30-65 year) Achievement and Nonachievement of Task • Achievement of the task results in a sense of gratification from personal and professional achievements and from meaningful contributions to others. The individual is active in the service of and to society. • Nonachievement results in lack of concern for the welfare of others and total preoccupation with the self. He or she becomes withdrawn, isolated, and highly self-indulgent, with no capacity for giving of the self to others.
  26. 26. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Ego Integrity vs. Despair(65 years to death) • Moment of reflecting back on life. • Understand and accept the meaning of temporary life. • Those feeling proud of their achievement will feel sense of integrity. • Sense of satisfaction with life well lived. • Integrity develops when with wisdom over a lifetime and can look back and see a life of meaning.
  27. 27. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Ego Integrity vs. Despair(65 years to death) • On contrary Despair with life occurs with complaints about regrets, not having enough time, not finding meaning in life or feels that life is wasted. • despair results when life’s event cannot be seen positively and the older is faced with a degree of devaluation and perhaps hostility. • Which leads to frustration and regret.
  28. 28. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Ego Integrity vs. Despair(65 years to death) Achievement and Nonachievement of Task • Achievement of the task results in a sense of self-worth and self-acceptance as one reviews life goals, accepting that some were achieved and some were • not. The individual derives a sense of dignity from his or her life experiences and does not fear death, rather viewing it as another stage of development. • Nonachievement results in self-contempt and disgust with how life has progressed. The individual would like to start over and have a second chance at life. He or she feels worthless and helpless to change. Anger, depression, and loneliness are evident. The focus may be on past failures or perceived failures. Impending death is feared or denied, or ideas of suicide may prevail.
  29. 29. Psychoanalytic Theory- Freud’s Theory of Psychosocial Development-Erikson’s Relevance to Nursing • Erikson’s theory is particularly relevant to nursing practice in that it incorporates sociocultural concepts into the development of personality. • Erikson provided a systematic, stepwise approach and outlined specific tasks that should be completed during each stage. This information can be used quite readily in psychiatric/mental health nursing. • Many individuals with mental health problems are still struggling to accomplish tasks from a number of developmental stages. • Nurses can plan care to assist these individuals in fulfilling the tasks and in moving on to a higher developmental level.
  30. 30. Psychoanalytic Theory- Freud’s Theory of object relations • Focuses on the relationship between a mother (or caregiver) and the infant and the effect of this relationship on the infant’s development of a sense of self. • Believes that individuals are born with a drive to build interpersonal relationships • The individual’s sense of self and others affects all subsequent interpersonal relationships
  31. 31. Psychoanalytic Theory- Freud’s Theory of object relations In Object Relations, the main developmental task is differentiating between the self and others The three main stages of development are: 1. Autistic stage: newborn – 1 month 2. Symbiotic stage: 1 – 5 months 3. Separation-Individuation stage: 5 – 24 months and further delineated phase III, the separation–individuation phase, into four sub phases. “Object” refers not only to literal objects, but to other people
  32. 32. Psychoanalytic Theory- Freud’s Theory of object relations Autistic Stage : newborn – 1 month • The infant is focused entirely on him or herself • Mostly unresponsive to external stimuli • Does not perceive others as separate beings
  33. 33. Psychoanalytic Theory- Freud’s Theory of object relations Symbiotic Stage 1 – 5 months • The infant begins to perceive the mother/caregiver as a “need-satisfying object” • The infant feels unity with the mother, but begins to understand that the mother is a separate being
  34. 34. Psychoanalytic Theory- Freud’s Theory of object relations Separation – Individuation Stage The Separation-Individuation Stage is made up of four sub-stages 1. Differentiation: 5 – 9 months 2. Practicing: 9 – 14 months 3. Rapprochement: 14 – 24 months 4. Object Constancy: after 24 months
  35. 35. Psychoanalytic Theory- Freud’s Theory of object relations Separation – Individuation Stage 1. Differentiation: 5 – 9 months • The infant’s attention shifts from being inwardly focused to outwardly focused • The infant begins to separate from the caretaker (for example, learning to crawl)
  36. 36. Psychoanalytic Theory- Freud’s Theory of object relations Separation – Individuation Stage 2. Practicing Sub-Stage: 9 – 14 months • The infant continues to separate from the caretaker • More autonomous functioning • The infant becomes more independently mobile and more active • Ex. walking, playing, etc.
  37. 37. Psychoanalytic Theory- Freud’s Theory of object relations Separation – Individuation Stage 3. Rapprochement Sub-Stage: 14 – 24 months • The baby begins to want to act independently • The baby moves away from his or her mother/caregiver, but regularly comes back to make sure that the caregiver is still there
  38. 38. Psychoanalytic Theory- Freud’s Theory of object relations Separation – Individuation Stage 4. Object Constancy Sub-Stage: after 24 months • The baby has an internalized mental representation of his or her caregiver and understands that the caregiver continues to exist even when they are not together
  39. 39. Psychoanalytic Theory- Freud’s Theory of object relations A transitional object is an object that the individual can mentally associate with a specific person when that person is not physically present Ex. a “security blanket” or for adults a piece of jewelry/heirloom
  40. 40. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau • Hildegard E. Peplau’s Interpersonal Relations in Nursing • Regarded as “mother of psychiatric nursing” • Born in 1909 , Pennsylvania • Diploma from Pottstown Hospital School of Nursing, • BA in interpersonal psychology from Bennington College Pennsylvania in 1931. • MA in psychiatric nursing from Colombia University, New York in 1947 • Her Theory was published in 1953 • Framework for psychodynamic nursing
  41. 41. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau • Theory was influenced by Harry Stack Sullivan’s theory of interpersonal relations. • Middle range, descriptive, classification theory • She led the way towards humane treatment of patients with behavior and personality disorders. • Nurses, she thought, could facilitate this through observation, description, formulation, interpretation, validation, and intervention. • She taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy.
  42. 42. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Key concepts include the following: • Nursing is a human relationship between an individual who is sick, or in need of health services, and a nurse especially educated to recognize and to respond to the need for help. • Psychodynamic nursing is being able to understand one’s own behavior, to help others identify felt difficulties, and to apply principles of human relations to the problems that arise at all levels of experience. • Roles are sets of values and behaviors that are specific to functional positions within social structures. Peplau identified the following nursing roles:  Resource person  Counselor  Teacher  Leader  Technical expert  Surrogate
  43. 43. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Phases of the nurse–client relationship are stages of overlapping roles or functions in relation to health problems, during which the nurse and client learn to work cooperatively to resolve difficulties. Peplau identified four phases: • Orientation • Identification • Exploitation • Termination (Resolution)
  44. 44. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Peplau’s Stages of Personality Development • Peplau (1991) identified four psychological tasks that she associated with the stages of infancy and childhood described by Freud and Sullivan. • In the context of nursing, Peplau (1991) related these four psychological tasks to the demands made on nurses in their relations with clients. • An outline of the stages of personality development according to Peplau’s theory is: Learning to Count on Others Learning to Delay Satisfaction Identifying Oneself Developing Skills in Participation
  45. 45. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Learning to Count on Others (Infancy) • Nurses and clients first come together as strangers. Both bring to the relationship certain “raw materials,” such as inherited biological components, personality characteristics (temperament), individual intellectual capacity, and specific cultural or environmental influences. • Peplau related these to the same “raw materials” with which an infant comes into this world. The newborn is capable of experiencing both comfort and discomfort • Clients with unmet dependency needs regress during illness and demonstrate behaviors that relate to this stage of development. • Peplau believed that, when nurses provide unconditional care, they help these clients progress toward more mature levels of functioning. This may involve the role of “surrogate mother,” in which the nurse fulfills needs for the client with the intent of helping him or her grow, mature, and become more independent.
  46. 46. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Learning to Delay Satisfaction (Toddlerhood) • Psychosexually, it is compared to the anal stage of development, when a child learns that, because of cultural mores, he or she cannot empty the bowels for relief of discomfort at will, but must delay to use the toilet, which is considered more culturally acceptable. • When toilet training occurs too early or is very rigid, or when appropriate behavior is set forth as a condition for receiving love and caring, tasks associated with this stage remain unfulfilled. The child feels powerless and fails to learn the satisfaction of pleasing others by delaying self-gratification in small ways • He or she may also exhibit rebellious behavior by failing to comply with demands of the mothering figure in an effort to counter the feelings of powerlessness • The child may accomplish this by withholding the fecal product or failing to deposit it in the culturally acceptable manner
  47. 47. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Learning to Delay Satisfaction (Toddlerhood) • Peplau described the following potential behaviors of individuals who have failed to complete the tasks of the second stage of development: • Exploitation and manipulation of others to satisfy their own desires because they are unable to do so independently • Suspiciousness and envy of others, directing hostility toward others in an effort to enhance their own self-image • Hoarding and withholding possessions from others; miserliness • Inordinate neatness and punctuality • Inability to relate to others through sharing of feelings, ideas, or experiences • Ability to vary the personality characteristics to those required to satisfy personal desires at any given time
  48. 48. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Learning to Delay Satisfaction (Toddlerhood) When nurses observe these types of behaviors in clients, it is important to : • Encourage full expression and to convey unconditional acceptance. • When the client learns to feel safe and unconditionally accepted, he or she is more likely to let go of the oppositional behavior and advance in the developmental progression.
  49. 49. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Identifying Oneself (Early childhood) • A child learns to structure self-concept by observing how others interact with him or her. • Roles and behaviors are established out of the child’s perception of the expectations of others. • When children have the impression that adults expect them to maintain more or less permanent roles as infants, they perceive themselves as helpless and dependent. • When the perceived expectation is that the child must behave in a manner beyond his or her maturational level, the child is deprived of the fulfillment of emotional and growth needs at the lower levels of development. • Children who are given freedom to respond to situations and experiences unconditionally (i.e., with behaviors that correspond to their feelings) learn to improve on and reconstruct behavioral responses at their own pace.
  50. 50. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Identifying Oneself (Early childhood) • In the initial interaction, it is difficult for the nurse to perceive the “wholeness” of the client, for the focus is on the condition that has caused him or her to seek help. • Likewise, it is difficult for the client to perceive the nurse as a “mother (or father)” or “somebody’s wife (or husband)” or as having a life aside from being there to offer assistance with the immediate presenting problem. • As the relationship develops, nurses must be able to recognize client behaviors that indicate unfulfilled needs and provide experiences that promote growth • Nurses must also be aware of the predisposing factors that they bring to the relationship. • Attitudes and beliefs about certain issues can have a deleterious effect on the client and interfere not only with the therapeutic relationship but also with the client’s ability for growth and development.
  51. 51. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Identifying Oneself (Early childhood) • Nurses must have knowledge and appreciation of their own concept of self to develop the flexibility required to accept all clients as they are, unconditionally. • Effective resolution of problems that arise in the interdependent relationship can be the means for both client and nurse to reinforce positive personality traits and modify those more negative views of self.
  52. 52. Psychoanalytic Theory- Freud’s A Nursing Model - Hildegard E. Peplau Developing Skills in Participation (Late childhood) • During this stage, the child develops the capacity to “compromise, compete, and cooperate” with others. • Failure to develop appropriate skills at any point along the developmental progression results in an individual’s difficulty with participation in confronting the recurring problems of life • It is not the responsibility of the nurse to teach solutions to problems, but rather to help clients improve their problem-solving skills so that they may achieve their own resolution. • Nurses can assist clients to develop or refine these skills by helping them to identify the problem, define a goal, and take the responsibility for performing the actions necessary to reach that goal.

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