GandDsu12.ppt

Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Nursing: A Concept-Based Approach to Learning, Volume One
North Carolina Concept-Based Learning Editorial Board
CONCEPT
Nursing:
A Concept-Based Approach to Learning
Volume One
Development
7

About
Growth and Development

• Growth refers to physical change, increase
in size
• Development refers to increase in
complexity of function
– Skill progression
– Capacity, skill to adapt to environment
• Continuous, orderly, sequential processes
– All humans follow same pattern
– Sequence of each stage predictable

Growth and Development, continued
– Learning helps or hinders process
– Each developmental stage has own
characteristics
– Cephalocaudal and proximodistal direction
– Development proceeds from simple to
complex
– Becomes increasingly differentiated
– Certain stages more critical than others
– Pace uneven

Factors Influencing Development
• Genetics
– Temperament
– Chromosomes and genes
 Carry messages that encode for characteristics,
diseases
 Sex chromosomes
 Autosomal chromosomes
– Disease can be caused by inherited gene or
by mutation that manifests in the disease

Factors Influencing
Development, continued
• Prenatal influences
– Mother’s nutrition, general state of health
– Substance ingestion
– Prescription, nonprescription medication
– Maternal illnesses
– Chronic maternal distress, depression
– Radiation, chemicals, environmental hazards

Factors Influencing
• Family and parenting
– Profile of family characteristics
– Families influence children profoundly
• Cultural influences
– Traditional practices
– Genetic variations
– Rules regarding patterns of social interaction
– Genetic traits

Factors Influencing
• Nutrition
– Essential to growth and development
– Poorly nourished
 More likely to get infections
 Not attain full height potential
– Prenatal nutrition

Factors Influencing
• Environment
– Living conditions
– Socioeconomic status
– Climate
– Community
• Health
– Injury, illness
– Prolonged, chronic illness

Theories
• Five major components of G & D
– Psychosocial
– Cognitive
– Moral
– Spiritual
– Biophysical
• Theories categorized around these areas

Freud—Psychosocial Theorist
• Unconscious mind
• Id
• Ego
• Superego
• Libido
• Must meet needs of each developmental
stage to move successfully to next
– Become fixated

Freud’s Five Stages of
Development
• Oral  birth – 11/2
• Anal  11/2 – 3
• Phallic  4 – 6
• Latency  6 – puberty
• Genital  puberty and after

Erikson—Psychosocial Theorist
• Life  sequence of developmental stages
or levels of achievement
• Health of personality depends on level of
success at each stage or crisis
• Stages reflect positive and negative
aspects of critical life periods
• Stress can cause regression to unresolved
stage

Erikson’s Eight Stages of
Development
• Infancy  birth – 18 months
• Early childhood  18 months – 3 years
• Late childhood  3–5 years
• School age  6–12 years
• Adolescence  12–18 or 20 years
• Young adulthood  18–25 years
• Adulthood  25–65 years
• Maturity  65 years–death

Havighurst—
Psychosocial Theorist
• Developmental tasks to be learned at each
stage of growth and development
• Provide framework to use to evaluate
person’s general accomplishments
• Categories are broad, limiting usefulness
• May be less relevant in multicultural
society

Havighurst’s Age Periods and
Developmental Tasks
• Infancy and early childhood
• Middle childhood
• Adolescence
• Early adulthood
• Middle age
• Later maturity

Vygotsky—
Psychosocial Theorist
• Social constructivist
• Adults guide children to learn
• Development depends on use of
– Language
– Play
– Extensive interaction

Peck—Psychosocial Theorist
• With increase in age of adult
– Physical capabilities, functions decrease
– Mental and social capacities increase
• Three developmental tasks in old age
– Ego differentiation vs. work-role preoccupation
– Body transcendence vs. body preoccupation
– Ego transcendence vs. ego preoccupation

Gould—Psychosocial Theorist
• Transformation central theme during
adulthood
– Stage 1  ages 16–18

Other Psychosocial Theories
• Jung’s Theory of Individualism
– With age, shift from external world toward
inner experience
• Disengagement Theory
– Older person and society at large  mutual,
reciprocal withdrawal
• Continuity Theory
– Successful aging involves maintaining or
continuing previous values, habits, family ties

Piaget—Cognitive Theorist
• Piaget’s Theory of Cognitive Development
– Manner in which people learn to think, reason,
use language
– Orderly sequential process
– Variety of new experiences (stimuli) must
exist before intellectual abilities can develop
– Person develops through each phase

Piaget’s Phases of Cognitive
Development
• Sensorimotor
• Preconceptual
• Intuitive thought
• Concrete operations
• Formal operations

Piaget’s Theory of Cognitive
Development
• Each phase has person using three
primary abilities
– Assimilation
– Accommodation
– Adaptation

Behaviorist Theory
• Learning takes place when individual’s
reaction is either positively or negatively
reinforced
• B.F. Skinner
– Operant conditioning
– Rewarded or reinforced behavior will be
repeated

Social Learning Theory
• Bandura
– Children learn attitudes, beliefs, customs,
values through social contacts with adults,
other children
– Imitate or model behavior
– People can choose how they act
– Self-efficacy
 Expectation that someone can produce a desired
outcome

Temperament Theory
• Chess and Thomas
– Child influences, is influenced by environment
– Parameters of response
– Personality characteristics displayed in
infancy often consistent later in life

Nine Parameters of Personality—
Chess and Thomas
• Activity level
• Rhythmicity
• Approach or
withdrawal
• Adaptability
• Threshold of
responsiveness
• Intensity of
reaction
• Quality of mood
• Distractibility
• Attention span and
persistence

Resiliency Theory
• Ability to function with healthy responses
even when experiencing stress
• Protective factors
• Risk factors
• Confronted with crisis
– Adjustment phase
– Adaptation phase

Ecologic Theory
• Bronfenbrenner
– Nature
– Nurture
– Emphasizes presence of mutual interactions
between child and close or remote settings
– Five systems of ecologic theory

Figure 7-4 Bronfenbrenner’s ecologic theory of development views the individual as interacting within five levels or
systems. Source: Redrawn from Santrock, J. W. (2005). Life span development. Madison, WI: Brown & Benchmark.
Based on Bronfenbrenner’s (1979, 1986) works in Contexts of child rearing: Problems and prospects. American
Psychologist, 34, 844–850; Ecology of the family as a context for human development: Research perspectives.
Developmental Psychology, 22, 723–742.

Moral Theories
• Moral development involves learning what
one should and should not do
– Moral  relating to right and wrong
– Morality  requirements needed to live
together in society
 Moral behavior  way a person perceives and
responds to those requirements
 Moral development  pattern of change in moral
behavior with age

Kohlberg—Moral Theorist
• 3 levels, 6 stages of moral development
– Preconventional
 Punishment and obedient orientation
 Instrumental relativist orientation
– Conventional
 Interpersonal concordance orientation
 Law-and-order orientation
– Postconventional
 Social contract legalistic orientation
 Universal ethical principle orientation

Gilligan—Moral Theorist
• Reported women often considered
Kohlberg’s dilemmas irrelevant
• Moral development proceeds through 3
levels
– Stage 1: Caring for oneself
– Stage 2: Caring for others
– Stage 3: Caring for self and others
• Women often see morality in integrity of
relationships

Fowler—Spiritual Theorist
• Development of faith as force that gives
meaning to life
– Undifferentiated
– Intuitive-projective
– Mythic-literal
– Synthetic-conventional
– Individuating-reflexive
– Paradozical-consolidative
– Universalizing

Westerhoff—Spiritual Theorist
• Faith as a way of being, behaving that
evolves from an experienced faith to an
owned faith
• Four stages
– Experienced faith
– Affiliative faith
– Searching faith
– Owned faith

Figure 7-5 Body proportions at various ages.

Infant: Birth–1 year
• Physical growth and development
– Rapid
– Milestones
• Cognitive development
– Brain continues to increase in complexity
• Psychosocial development
– Solitary play
– Manipulation of toys

Infant: Birth–1 year, continued
• Personality and temperament
– Differences in responses to environment
– Nursing assessment identifies personality
• Communication
– Express comfort by soft sounds, cuddling
– Nonverbal methods
– Nursing assessment identifies delays
– Denver II Developmental Test

Figure 7-6 Garrett shows us that an 8-month-old child can play with blocks, demonstrating physical, cognitive, and
social capabilities.

Toddler: 1–3 years
– Rate of growth slows
– Gross motor activity develops rapidly
– Milestones
– Sensorimotor to preoperational
– Early language
– Rudimentary problem solving

Toddler: 1–3 Years, continued
– Motor skills changing
– Parallel play
– Physical skills
– Retains most characteristics from infancy
– Some changes
– Increasing independence

Toddler: 1–3 Years, continued
• Communication
– Capacity for language skill development
greatest
– Receptive speech far outpace expressive
speech
– Vocabulary of almost 1,000 words
– Expressive jargon
– Tantrums
– Parents promote communication

Figure 7-7 A, Two children are displaying typical parallel play, since they enjoy playing near other children, but are not
engaging in social interactions with each other. Which cognitive and motor skills are these children developing?
A

Figure 7-7 (continued) B, Imitative play such as pushing and pulling a vacuum allows this toddler to develop gross
and fine motor skills.
B

Preschool Child: 3–6 years
– Growth steady and slow
– Physical skills continue to develop
• Milestones
– Preoperational thought

Preschool Child: 3–6 years,
continued
– More independent in establishing
relationships
– Interacts closely with children and adults
• Play
– Interactive and associative
– Large and fine motor activities
– Dramatic play

continued
– Characteristics observed in infancy tend to
persist
– May need assistance in new situations
– Encourage parents to see children as
individuals
 May not learn in same way

continued
• Communication
– Vocabulary increases to over 2,000 words
– Complete sentences of several words
– Sophisticated speech
– Concrete visual aids
– Allow time for child to integrate explanations
– Verbalize frequently to child
– Drawings, stories to explain care
– Accurate names for bodily functions

School-Age Child: 6–12 years
– Boys, girls close in size and proportions
– Rapid increases in size
– Nutritional needs increase dramatically
– Loss of deciduous teeth
– Milestones

School-Age Child: 6–12 years,
continued
– Concrete operation thought at about 7
– Learns concept of conservation
– Understands that healing will occur
– Play
 Understands team roles
 Cooperates
 Increasing desire to spend time with friends

School-Age Child: 6–12 years,
continued
 Separation from playmates (hospitalization) can
lead to feelings of sadness
– Personality and temperament
 Enduring aspects of temperament continue
 Child classified as “difficult” may have difficulty in
classroom
– Communication
 Learns how to correct lingering pronunciation,
grammatical errors
 Communication strategies

School-age Child: 6–12 years,
continued
• Sexuality
– Need information about bodily changes
– Interested in sexual issues
– Friends, media common sources of
information
– Appropriate, inappropriate touch
– Encourage child to go to more than one
person if inappropriate touch occurs

Adolescent: 12–18 years
– Puberty
– Growth spurt
– Male, female patterns of fat distribution
– Sweating, odor to perspiration
– Body organs fully mature
– Adult doses of medications
• Milestones

Adolescent: 12–18 years, continued
– Formal operational thought
– Develops ability to reason abstractly
– Thinks and acts independently
 Rebels against patents
– Sports and school activities
– Quiet activities
– Increasing communication, peer interaction

• Activities
– Drive, ride buses
– Participation in sports
– Hanging out
– Peers important
– Same sex interactions predominate
• Personality and Temperament
– Characteristics remain stable
– Support teen’s uniqueness

• Communication
– All parts of speech used, understood
– Increasingly leaves home base
– Has need to leave past, be different
– Breaks rules
– Privacy
– Give opportunity to ask questions alone
– Choice about parental presence

– Teen rooms in hospitals
– Peer support
– Choices
– Guidelines
 Written, verbal
 Safe exploration of topics

• Sexuality
– Maturation of body
– Growing interactions with members of
opposite sex
– Needs clear information about body, sexuality
– Alternatives, support for decisions
– Sexual minority groups

Adult
• Young adult 18–25
– Peak of physical development
– Psychosocial stressors
– Physical assessment
– History
• Middle adult 40–65
– Similar physical status, function of young adult
– History

Adult
• Older adult
– Further divided
 Young-old – 65–74
 Middle-old – 75–84
 Old-old – 85+
– History

MULTISYSTEM EFFECTS OF Aging

Applying Growth and Development
Concepts to Nursing
• Using developmental theories
– Guiding assessment
– Tasks of specific age
– Individual variations
– Explaining behavior
• Provides direction for nursing interventions

GandDsu12.ppt

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