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Critical Thinking in nursing for nursing students
- 1. Fundamentals of Nursing I Dr. Kusrini Kadar
- 2. Instructor Dr. Kusrini Kadar FUNDAMENTALS OF NURSING I Topic 1: Developmental Theory 18th Jan 2024
- 3. PLO1: Integrate core scientific knowledge to provide therapeutic, holistic care that is culturally appropriate, safe and tailored to the needs of the individual patient. CLO1: Utilize knowledge of basic concept in nursing care for delivery of nursing care for client across life span. CORRESPONDING PLO & CLO 3
- 4. 01 02 03 04 05 06 4 Learning Outcome Differentiate between the terms growth and development Describe essential principles of growth and development List factors that influence growth and development Describes stages of growth and development according to various theorists Discuss theories of Freud, Erikson, Havighusrt, Gould, Levinson, Piaget, Kohlberg, Gilligan, and Fowler Describe the importance of incorporating theories of growth and development in assessing and planning nursing care for individuals After learning the topic, students will be able to:
- 5. Introduction • Understanding the stages of growth and development is essential in delivery of nursing care to client and family • Nurses need to understand this stages to educate the caregivers/family on the developmental task • The Joint Commission for hospital accreditation required healthcare providers to be knowledgeable about the characteristics and needs of the age groups April 14, 2024
- 6. Terms of Growth and Development • GROWTH – measurable physical changes that occur throughout a person’s life • Examples: height, weight, body shape, dental structure (teeth) • DEVELOPMENT – refers to the changes in intellectual, mental, and emotional skills that occur over time • Examples: think, maturation 6
- 7. Main types of Growth and Development • Physical – body growth • Mental – intellectual development, problem solving • Emotional – feelings, includes dealing with love, hate, joy, fear, excitement, and other similar feelings • Social – interactions and relationships with other people 7
- 8. Principles of Growth and Development • Orderly and sequential, as well as continuous and complex • Follow regular and predictable trends • Both differentiated and integrated • Different aspects occur at different stages and at different rates and can be modified • The pace is specific for each person 8
- 9. Factors influencing Growth and Development 1. Genetics – makeup influences weight, height, eye color, hair color, skin pigmentation 2. Temperament – the way individuals respond to their external and internal environment 3. Family – involved in children’s physical and psychologic well-being and development 9
- 10. Cont’d 4. Nutrition – adequate nutrition is an essential component in growth and development 5. Environment – the living conditions (e.g. homeless), socioeconomic status, climate, and community (e.g. provides developmental support vs exposes the child to hazards) 6. Health – illness, injury, or congenital conditions (e.g. congenital cardiac conditions) can affect growth and development 7. Culture – cultural customs can influence growth and development 10
- 11. Life stages 1) Infant (aged 0-12 month) 2) Toddler (aged 1-3) 3) Pre-schooler (aged 3-6) 4) School-aged (aged 6-12) 5) Adolescence (aged 12-20) 6) Young adult (aged 21-40) 7) Middle Adulthood (aged 41-65) 8) Young-old (aged 65-74) 9) Middle-old (aged 75-84) 10) Old-old (>85) 11
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- 13. Growth and Development Theory 1. Biophysical theory 2. Psychosocial theory 3. Cognitive development theory 4. Moral development theory 5. Spiritual development theory 13
- 14. Growth and Development Theory – Biophysical Theory • Biophysical Theory – theory describes the development of the physical body – how it grows and changes • Arnold Gesell – is often identified as the “father of child development” 14
- 15. Expected developmental mile stones 15
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- 19. Growth and Development Theory – Psychosocial Theory 1. Sigmund Freud (1856 – 1939) 19
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- 22. Fixation • If the individual does not achieve satisfactory progression at one stage, the personality becomes fixated at that stage. • Fixation is immobilization or the inability of the personality to proceed to the next stage because of anxiety. 22
- 23. • 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 24
- 24. 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 25
- 25. Growth and Development Theory – Psychosocial Theory 2. Erikson (1902–1994) • Eight stages of development • Nurses should be aware of indicators of positive and negative resolution of each developmental stage. • Nurses can enhance a client’s development - being aware and assisting with the development of coping skills related to the stressors experienced at that specific level. • For example, a 10-year-old child (industry versus inferiority) can be encouraged to be creative, to finish schoolwork, and to learn how to accomplish these tasks within the limitations imposed by health status. 26
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- 27. • 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 28
- 28. Growth and Development Theory – Psychosocial Theory 3. Havighusrt (1900-1991) • Concept – learning is basic to life and individuals continue to learn throughout life • Developmental task is “a task which arises at or about a certain period in the life of an individual, successful achievement of which leads to his [sic] happiness and to success with later tasks, while failure leads to unhappiness in the individual, disapproval by society, and difficulty with later tasks” (Havighurst, 1972, p. 2). • Havighurst’s developmental tasks provide a framework that can used by nurses to evaluate the client’s general accomplishments 29
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- 30. Growth and Development Theory – Psychosocial Theory 3. Gould • Concept – adult development • “Adults continue to change over the period of time considered to be adulthood and developmental phases may be found during the adult span of life” • According to Gould, the 20s is the time when an individual assumes new roles; in the 30s, role confusion often occurs; in the 40s, the individual becomes aware of time limitations in relation to accomplishing life’s goals; and in the 50s, the acceptance of each stage as a natural progression of life marks the path to adult maturity. 31
- 31. Gould’s 7 stage development 32
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- 33. Growth and Development Theory – Cognitive Theory 4. Piaget (1896–1980) • Cognitive development refers to the manner in which individuals learn to think, reason, and use language and other symbols • The most widely known cognitive theorist is Jean Piaget (1896–1980). • Piaget’s cognitive developmental process is divided into five major phases: 1. the sensorimotor phase, 2. the preconceptual phase, 3. the intuitive thought phase, 4. the concrete operations phase, and 5. the formal operations phase. 34
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- 35. Growth and Development Theory – Moral Development Theory 5. Kohlberg (1927–1987) • Moral development progresses through three levels and six stages. • Levels and stages are not always linked to a certain developmental stage or age because some individuals progress to a higher level of moral development than others 6. Gilligan (1936–Present) • Gilligan’s theory views girls and women as developing a morality of response and care, and boys and men as developing a morality of justice. 36
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- 39. Stage 1: caring for oneself Stage 2: caring for others Stage 3: caring for self and others 40
- 40. • 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 41
- 41. Growth and Development Theory – Spiritual Development Theory 5. Fowler • Moral development progresses through three levels and six stages. • Levels and stages are not always linked to a certain developmental stage or age because some individuals progress to a higher level of moral development than others 6. Westerhoff • Experience faith (infant – early adolescent) • Affiliate faith (late adolescent) • Searching faith (young adulthood) • Owned faith (middle-older adulthood) 42
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- 44. Holistic framework for Nursing • Knowledge of developmental milestones is essential for prompt identification of problems and comprehensive intervention • The infant who does not sit, crawl, or walk at expected times • The adolescent girl who has not experienced menarche at the expected time • The adult who has failed to develop adequate problem-solving skills 45
- 45. Group work Point of discussion: • Physical development • Psychosocial development • Cognitive • Moral • Spiritual • Health risks/nursing care Reading course: 1. Kozier & Erb's Fundamentals of Nursing: Concepts, Process and Practice – Chapter 24 2. Potter & Perry – Chapter 12-14 46 Group age Group Infant (aged 0-12 month) Toddler (aged 1-3) Pre-schooler (aged 3-6) Group 1 School-aged (aged 6-12) Adolescence (aged 12-20) Group 2 Young adult (aged 21-40) Middle Adulthood (aged 41- 65) Group 3 Young-old (aged 65-74) Middle-old (aged 75-84) Old-old (>85) Group 4
- 46. Group Report • Each students will have individual report based on group decision (part to be reported) • All the report will be collected as one group report and will submit the hard copy to me one week after the presentation – can submit to Mr. Zakir desk if I am not in my office • All point of discussion should be based on references • Submit also 10 multiple choices questions related to your topic with answers 47
- 47. 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. 48
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- 53. Reading resources • Kozier & Erb's Fundamentals of Nursing: Concepts, Process and Practice – Chapter 24 • Potter & Perry Fundamentals of Nursing – Chapter 12-14 54
- 54. 55 Q&A Session
Editor's Notes
- Genetics – makeup influences weight, height, eye color, hair color, skin pigmentation Note for nurses: genetic inheritance provides awareness of the client’s risk for developing disease – example: cancer and skin discoloration Temperament – the way individuals respond to their external and internal environment May persist throughout the lifespan – be caution not to label or categorize infants and children with bad temper child Family – involved in children’s physical and psychologic well-being and development Parents set expected behaviors and model appropriate behavior
- Nutrition – adequate nutrition is an essential component in growth and development Poorly nourished children are more likely to have infections than are well-nourished and may not attain their full height potential Environment – few factors can influence growth and development include the living conditions (e.g. homeless), socioeconomic status, climate, and community (e.g. provides developmental support vs exposes the child to hazards) Health – illness, injury, or congenital conditions (e.g. congenital cardiac conditions) can affect growth and development Being hospitalized is stressful for a child and can affect the coping mechanism of the child and family. Prolonged or chronic illness may affect normal developmental processes Culture – cultural customs can influence growth and development Nutritional practices may influence the rate of growth of infants Childrearing practice may influence development
- Sigmund Freud (1856 – 1939) Concept – unconscious mind; defense mechanism; and the id, ego, and superego The unconscious mind is the part of an individual’s mental life of which the individual is unaware. The id resides in the unconscious and, operating on the pleasure principle, seeks immediate pleasure and gratification The ego, the realistic part of the individual, balances the gratification demands of the id with the limitations of social and physical circumstances The superego contains the conscience and the ego ideal. Freud’s theory emphasizes the effect of instinctual human drives on behavior. Freud identified the underlying stimulus for human behavior as sexuality, which he called libido. Libido is defined as general pleasure-seeking instincts rather than purely genital gratification. The four major components of the mind according to Freud’s theory are the unconscious mind, the id, the ego, and the superego: The unconscious mind contains memories, motives, fantasies, and fears that are not easily recalled but that directly affect behavior. The id is the 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 the id’s impulses cannot be satisfied. (Defense mechanisms are discussed in Chapter 43.) The ego is the 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. The ego includes intelligence, memory, problem solving, separation of reality from fantasy, and incorporation of experiences and learning into future behavior. Freud noted that the death of a loved one can result in the loss of a person’s sense of identity, but once the loss is accepted, the ego is able to reconcile the loss and search for new attachments. Development of the ego allows the infant, by age 6 months, to view self as separate from others and to begin to alter behaviors in response to cues. Ego development continues throughout life. The superego is the 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 actions. The superego represents the internalization of rules and values so that socially acceptable behavior is practiced.
- If the individual does not achieve satisfactory progression at one stage, the personality becomes fixated at that stage. Fixation is immobilization or the inability of the personality to proceed to the next stage because of anxiety. For example, making toilet training a positive experience during the anal stage enhances the child’s feeling of self-control. If, however, the toilet training was a negative experience, the resulting conflict or stress can delay or prolong progression through a stage or cause an individual to regress to a previous stage.
- Physical appearance and growth have a predetermined genetic base in inheritance patterns carried on the chromosomes.
- 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. Freud defined the id as the part of the mind concerned with self-gratification by the easiest and quickest available means.
- Erikson (1902–1994) Erik H. Erikson (1963, 1964) adapted and expanded Freud’s theory of development to include the entire lifespan, believing that individuals continue to develop throughout life. Eight stages of development Nurses should be aware of indicators of positive and negative resolution of each developmental stage. Nurses can enhance a client’s development - being aware and assisting with the development of coping skills related to the stressors experienced at that specific level. For example, a 10-year-old child (industry versus inferiority) can be encouraged to be creative, to finish schoolwork, and to learn how to accomplish these tasks within the limitations imposed by health status.
- 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.
- Piaget (1896–1980) Cognitive development refers to the manner in which individuals learn to think, reason, and use language and other symbols - It involves an individual’s intelligence, perceptual ability, and ability to process information The most widely known cognitive theorist is Jean Piaget (1896–1980). His theory of cognitive development has contributed to other theories, such as Kohlberg’s theory of moral development and Fowler’s theory of the development of faith Piaget’s cognitive developmental process is divided into five major phases: the sensorimotor phase, the preconceptual phase, the intuitive thought phase, the concrete operations phase, and the formal operations phase.
- 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.
- Growth and development theories are useful to nurses as assessment parameters because alterations in expected patterns are indicators for early intervention. Following are situations in which knowledge of developmental milestones is essential for prompt identification of problems and comprehensive intervention: • The infant who does not sit, crawl, or walk at expected times • The adolescent girl who has not experienced menarche at the expected time • The adult who has failed to develop adequate problem-solving skills
- 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.