Intro

• ID

  • “Baby”

  • Part of the personality that wants instant gratification

• Super Ego

  • “Good 2 shoes”

  • Part of the personality that is strict and rigid. Maintains perfection and order

• Ego

  • Arbitrates between id and super ego

  • Equally both parts

  • Makes up our personality

Homeostasis Erikson:

• Developmental stages associated with specific task or crises » Everyone has a different perception

  • Critical Period

    • A point in which the individual is vulnerable

    • How does the person respond?

    • You can tell if a person has mastered developmental stage depending how they handle the situation

• Tasks may be completely, partially or not resolved; outcome may affect future stages.

  • Task achievement is crucial to personality development and self concept

• Task resolution » healthier personality

  • Mastery of a stage is built satisfactory completion of the previous stage

    • 2 components (favorable/unfavorable)

    • Can’t move to next stage without completing the previous ones

  • Although stage is mastered, in times of crisis, you can fall back to previous stages

    • May have to re-master

• Failure to resolve tasks » may result in damage to ego

  • Affects ability to achieve the next stage/task

  • Regress a stage back

Erikson’s Stages of Development

Infancy (baby)

• Birth to 18 months

• Trust vs. Mistrust

  • Trust in individuals, trust in the environment » all needs are met

  • Positive Resolution

    • Trust others

  • Negative Resolutions

    • Mistrust » can lead to difficulty bonding

    • Caused by a discontinuance of care, and loss of separation

Early childhood/toddler

• 18 months to 3 years » Independence is key

• Autonomy vs. Shame and Doubt

  • “I can be on my own”

  • Attach value to an autonomous will

  • Positive Resolution

    • Self control, without loss of self esteem

  • Negative Resolution

    • Compulsive

    • Self-restraint

    • Doubt themselves- child will accept defeat (especially with those who are perceived to be bigger than them)

    • Defiant » Tantrums if not allowed to do things themselves

Late Childhood/Preschooler

• 3 to 5 years » Try new things and feeling good about accomplishments

• Initiative vs. Guilt

  • Learning degree to which they can assert themselves and how they can influence the environment

  • Positive Resolution

    • Contribute to the community and their environment

  • Negative Resolution

    • Lacking self confidence

    • Pessimistic

    • Fear of wrong doing

    • Over controlling

    • Over restriction of their own activity

    • Experiments w/ imagination

School Age

• 6 to 12 years » Begins to create/develop

• Industry vs. Inferiority

  • “Am I competent”

  • Positive

    • Beginning to create , develop and manipulate their environment

    • Have a sense of perseverance

    • Starts building confidence

    • Build self-esteem to prevent from feeling inferior

  • Negative

    • Lose hope

    • Sense of being only “okay”/mediocre

    • Withdrawn from peers

    • Social isolation

    • Feeling of inferiority

Adolescence

• 12-20 years

• Identity vs Role confusions » awkward time in adolescence

  • “Who am I? / What do I want in my life?” » “finding yourself”

  • Positive

    • Coherent sense of self

    • Plan to actualize their own ability and future

  • Negative

    • Feeling confused about their identity

    • Indecisive

    • Anti-social behavior

Young Adulthood

• 18-25 Years

• Intimacy vs. Isolation » Relationship formation/ connecting w/ others

  • Can I form a meaningful relationship with others?

  • Positive

    • Develop and intimate relationship and are committed

  • Negative

    • Impersonal relationship

    • Avoid relationships » Isolation

    • Cannot solidify lifestyle commitments

Adulthood

• 25-65 years

• Generativity vs Stagnation

  • How can I be of service to others

  • Positive

    • Develop creativity and concern for others

  • Negative

    • Person becomes self-indulgent/ self-concerned

    • Lack of interest and commitment with others

    • “all about me”

Maturity

• 65 years - death

• Integrity vs. Despair

  • How did I do? » Reminiscent

• Positive

  • Accept their worth and uniqueness of life

  • Accept death

• Negative

  • Sense of loss

  • Has regret, hatred for people or events that happened in their life

  • Regrets life choices

Culture

• Thoughts

• Communications

• Actions

• Customs

• Beliefs, values

• Institutions of racial, ethnic, religious, or social groups » prevents Biases

Contributing Factors

• Developmental

  • Critical Time

    • Period in life when person’s ability to adapt is limited because of their age

    • Linked to age

    • Some people who experience trauma at a certain age can be catastrophic

• Physical

  • Trauma

    • Ex: burn, motor vehicle accident, violence

  • Physiological

    • Illness

      • Ex; cancer, neuromuscular diseases

• Psycho/socio/cultural

  • Fear

  • Cultural background

  • Gender

• Chemical

  • Substances

    • Prescription drugs

    • Alcohol

    • Illegal substances

  • Microbiological

    • TB, Aids/HIV, Hepatitis, Zika

    • All have negative connotations associated with them

Clinical Manifestations

• Anxiety

  • Common reaction to stress » threat to self

  • Caused by emotional conflict

  • Occurs in levels, stages and degrees

  • Happens in reaction to something felt or perceived as danger

  • Described as

    • Vague and uneasy feeling

    • Feeling of dread

    • Apprehension

    • Does not occur/respond to a specific threat

  • Can be experienced at a conscious or subconscious level

  • Can be indistinguishable from fear at times

• Fear

  • More specific

    • Attached to something, Ex; fear of spiders

• Anxiety has 2 components

  • Physiologic

    • Can change vital signs - sympathetic nervous system - “Fight or flight”

    • Can be so devastating it can change the way someone acts

    • Change in appetite

    • Pupil dilation

    • Pulse rises, respirations, and BP rises

    • Mouth can be dry

    • Diaphoresis (sweating)

  • Psychological

    • Irritable/angry

    • Restless

    • Crying

    • Dizziness

    • Nervous

    • Sleep pattern disturbances

    • Emotional outburst

    • Loss in motivation

    • Decreased productivity

    • Decrease urinary output

• Contributing Factors

  • Family structure

  • Past experience

  • Developmental level

  • Coping mechanisms

Nursing Interventions

• Show respect- know their name (don’t use honey, sweetie)

• Identify strength

  • Use of past coping strategies

    • Talk with the patient

    • Identify past stressful situations that they overcame

  • Providing factual information

    • Decrease the fear of the unknown

  • Fostering autonomy

    • Allow patients to participate in their care

  • Incorporate family

    • Able to adapt better to lifestyle changes

  • Help patient adapt good coping strategies

    • Cognitive

      • The way they are emotionally connected

    • Behavioral

      • Change in behavioral patterns

    • Time management/time blocking

    • Emotional focus strategy

  • Talk to your patient

    • Refer to social groups

  • Lifestyle changes/modifications

  • Deep breathing

  • Communication techniques

  • Learn about patient’s culture

All interventions listed help reduce the patient’s anxiety