Untitled Flashcards Set

• Erik Erikson: Focuses on psychosocial development across eight stages, emphasizing the impact of social experiences on personality development.

• Jean Piaget: Concentrates on cognitive development, outlining how children acquire knowledge through stages, from sensory experiences to abstract reasoning.

• Lawrence Kohlberg: Explores moral development, detailing how individuals progress through stages of moral reasoning from obedience to universal ethical principles.

• These theories provide frameworks for understanding behaviors and guiding interventions in nursing practice.

• Each theory intersects at various life stages, influencing health promotion strategies.

• Understanding these theories aids nurses in tailoring education and interventions to developmental stages.

Application of Theories in Nursing Practice

• Nurses must assess the developmental stage of each child to provide appropriate health education and interventions.

• For example, teaching impulse control aligns with Erikson's stage of 'Initiative versus Guilt'.

• Piaget's stages guide nurses in understanding cognitive abilities, such as recognizing magical thinking in preschoolers.

• Kohlberg's moral reasoning stages help nurses address ethical dilemmas in pediatric care.

• Developmental theories inform the creation of age-appropriate educational materials for parents and caregivers.

• Continuous education on these theories is essential for effective pediatric nursing.

Understanding Growth and Development in Healthcare

Knowing how people grow and develop helps healthcare professionals predict, identify, and prevent health problems.

• Growth refers to physical changes from prenatal stages to old age. It can mean improvement or decline.

• Development includes biological, cognitive, and emotional changes that begin at conception and continue throughout life. While it typically progresses forward, some diseases can slow or reverse development.

Each person grows and develops at their own pace, but successfully completing each stage is crucial for overall health. Struggles in one stage can make future development harder, while success supports well-being.

As a nurse, understanding life span development helps in caring for clients of all ages. This course introduces key developmental theorists who provide useful frameworks for recognizing normal and abnormal behaviors.

Why Developmental Theories Matter

These theories help nurses:

• Identify typical vs. delayed development

• Make informed clinical decisions

• Choose appropriate care strategies based on a client’s developmental stage

Development isn’t just about physical health—it also includes achieving key life milestones. Missing a milestone can affect future development, while reaching them promotes well-being.

Theorists and Their Stages

This course will explore three major developmental theories:

Kohlberg’s Moral Development

• Preconventional (Self-interest)

• Conventional (Social rules)

• Postconventional (Ethical principles)

Piaget’s Cognitive Development

• Sensorimotor (Birth–2 years)

• Preoperational (2–7 years)

• Concrete Operational (7–11 years)

• Formal Operational (11+ years)

Erikson’s Psychosocial Development

• Trust (Infancy)

• Autonomy (Toddler)

• Initiative (Preschool)

• Industry (School-age)

• Identity (Adolescence)

• Intimacy (Young adulthood)

• Generativity (Middle adulthood)

• Integrity (Old age)

Erikson's Psychosocial Development

Erik Erikson’s Theory of Psychosocial Development

Erik Erikson, a German-American psychologist, developed a theory on psychosocial development, emphasizing the role of family, society, and culture in shaping human growth. Influenced by Sigmund Freud, Erikson believed that individuals must successfully complete specific tasks at each stage to move forward in their development.

Key Concepts of Erikson’s Theory

• Development happens in stages, each building on the success of the previous one.

• Every stage presents a core conflict with both a positive and negative outcome.

• Even after mastering a stage, challenges may arise during stressful or new situations.

Erikson’s Stages of Psychosocial Development

This framework helps nurses and healthcare professionals understand how individuals navigate life’s challenges and supports effective patient care based on their developmental needs.

Stages of Development

• Trust vs. Mistrust (0-1 year): Infants learn to trust caregivers for basic needs.

• Autonomy vs. Shame and Doubt (1-3 years): Toddlers develop independence and self-control.

• Initiative vs. Guilt (3-6 years): Preschoolers assert power and control through directing play and other social interactions.

• Industry vs. Inferiority (6-12 years): School-aged children develop a sense of pride in accomplishments and abilities.

• Each stage presents unique challenges and opportunities for health promotion.

• Nurses should provide education that aligns with the psychosocial needs of each developmental stage.

Health Promotion Strategies

• For infants, emphasize the importance of secure attachments and responsive caregiving.

• For toddlers, promote autonomy through safe exploration and encourage self-care skills.

• For preschoolers, teach social skills and cooperative play to foster initiative.

• For school-aged children, support academic and social skills to build industry.

• Use role modeling and positive reinforcement to encourage healthy behaviors.

• Provide resources for parents to understand and support their child's psychosocial development.

Piaget's Cognitive Development

Jean Piaget’s Theory of Cognitive Development

Piaget’s theory explains how children’s thinking, reasoning, and perception develop over time. As children grow, they move through different stages of cognitive development, building knowledge and adapting to their environment.

Example: School-aged children (7–11 years) are in the concrete operational stage, where they develop logical thinking.

This theory helps educators, parents, and healthcare providers support children’s cognitive growth at each stage.

Stages of Cognitive Development

• Sensorimotor Stage (0-2 years): Infants learn through sensory experiences and manipulating objects.

• Preoperational Stage (2-7 years): Children begin to use language and think symbolically, but their thinking is intuitive and egocentric.

• Concrete Operational Stage (7-11 years): Logical thinking develops, but it is limited to concrete objects.

• Formal Operational Stage (12 years and up): Abstract reasoning and hypothetical thinking emerge.

• Understanding these stages helps nurses tailor educational approaches to cognitive abilities.

• Nurses should assess cognitive development to provide appropriate health education.

Age-Appropriate Health Education

• For infants, focus on sensory stimulation and safe exploration.

• For toddlers, use simple language and visual aids to explain health concepts.

• For preschoolers, incorporate play-based learning to teach health and safety.

• For school-aged children, engage them in discussions about health choices and consequences.

• Encourage critical thinking and problem-solving in older children.

• Provide resources that align with cognitive development stages.

Kohlberg's Moral Development Theory

Kohlberg’s theory explains how people develop a sense of right and wrong from childhood to adulthood. He believed that moral growth happens in three levels, each with two stages.

Kohlberg built on Piaget’s theory, studying how people respond to moral dilemmas to understand their reasoning. His work helps explain how moral thinking evolves over time.

Stages of Moral Development

• Preconventional Level: Morality is based on obedience and punishment.

• Conventional Level: Morality is based on social norms and the desire to maintain relationships.

• Postconventional Level: Morality is based on abstract reasoning and principles.

• Understanding these stages helps nurses address ethical issues in pediatric care.

• Nurses can guide children in understanding the consequences of their actions.

• Moral development influences decision-making and behavior in children.

Implications for Nursing Practice

• Nurses should assess the moral reasoning of children to provide appropriate guidance.

• Encourage discussions about rules and consequences to foster moral development.

• Use real-life scenarios to help children understand ethical dilemmas.

• Promote empathy and understanding of others' perspectives.

• Provide resources for parents to support moral development at home.

• Continuous education on moral development is essential for effective pediatric nursing.

Health Promotion Across Developmental Stages

Health Promotion for Newborns

• Emphasize safety and injury prevention strategies, such as safe sleeping practices.

• Promote exclusive breastfeeding for the first six months and gradual introduction of solid foods.

• Educate parents on immunization schedules and the importance of staying informed.

• Discuss the significance of monitoring developmental milestones.

• Provide resources for nutrition and feeding practices.

• Encourage regular pediatric check-ups for early detection of health issues.

Safety and injury prevention

•SAFE PAD is an acronym to remember for common infant injuries, risk factors, and safety precautions.

•Suffocation and Sleep Position​

•In accordance with the recommendations of the AAP, position infants for sleep on their backs on a firm sleep surface to decrease the risk of sudden infant death syndrome (SIDS)

•Remove plastic bags and balloons from the environment. Avoid blankets, stuffed animals, and pillows in the crib. Infants should always be placed on their backs for sleeping. Crib slats should be no more than 6 cm apart. Use a firm crib mattress. Avoid exposure to second-hand smoke.

•Asphyxia, Aspiration, and Accidents​

•Avoid toys with small parts. Ensure table food is cut into small, noncircular bites. Avoid small, round, sticky foods. Prevent accidents with supervision and a safe home environment. 

•Falls​

•As the child becomes more mobile, place gates at the top and bottom of stairs. Protect hard surfaces with padding, such as coffee tables and fireplaces.

•Electrical Burns and Sunburns​

•Insert protective covers into electrical outlets. Use sunscreen appropriately and cover exposed body parts when sun exposure is likely. 

•Poisoning​

•Place all chemicals, medications, and vitamins in high or locked cabinets.

•Automobile Safety​

•An essential component of discharge teaching is the use of a federally approved car seat for transporting the newborn from the health care agency or birthing center to home. Automobile injuries are a leading cause of death in children in the United States. Many of these deaths occur when the child is not properly restrained

•Place the infant in a rear-facing infant car seat in the back seat of the car until age 2 years. 

•The car seat should be positioned at a 45-degree angle, which prevents the infant from slumping and airway obstruction occurring.

•Only two fingers should fit between the harness and the infant. No thick blankets or clothing should be in between the infant and the restraint. 

• Drowning​

•Maintain safety and close observation when around water. This includes large bodies of water, such as lakes or pools, as well as toilet bowls and mop water buckets. 

•Unintentional injury from all accidents, such as motor vehicle accidents, suffocation, falls, or poisoning, is a major cause of death in children 6 to 12 months old 

•Child maltreatment includes intentional physical abuse or neglect, emotional abuse or neglect, and sexual abuse of children, usually by adults. More children suffer from neglect than any other type of maltreatment.

Nutrition

•Both the AAP and the U.S. Department of Health and Human Services (USDHHS) recommend human breastmilk for the first year of life. The use of whole cow’s milk, 2% cow’s milk, or alternate milk products before the age of 12 months is not recommended

•Breastfeeding only for the first 6 months of life. 

•Solid foods may be introduced starting at 6 months of age, while breastfeeding continues for at least 2 years and beyond if possible. 

•If the mother chooses not to breastfeed, the use of commercially-prepared, iron-fortified infant formula should be used for the first year of life . 

•The infant can be switched to whole cow’s milk at age 1 year. ​

•Introducing iron-fortified rice cereal, followed by complementary foods (fruits and vegetables) one at a time for a several-day trial. 

•Fruit juice is not a necessary part of an infant's diet and, eating the whole fruit is preferred to fruit juice consumption. Fruit juice should not be introduced before 12 months of age and should be limited to 4 ounces per day. 

Sleep

•Sleep patterns vary among infants, with many having their days and nights reversed until 3 to 4 months of age.

•By 6 months most infants demonstrate nocturnal sleep patterns, sleeping between 9 and 11 hours at night. 

•Most infants take one or two naps a day by the end of the first year.

Immunizations

•The recommended schedule for immunizations changes as new vaccines are developed and advances are made in the field of immunology. Stay informed of the current policies and direct parents to the primary caregiver for their child’s schedule.

Health Promotion for Toddlers

• Focus on safety measures, including childproofing the home and supervision during play.

• Promote a balanced diet and healthy eating habits.

• Discuss the importance of patience and consistency in toilet training.

• Educate parents on the risks of choking and poisoning.

• Encourage physical activity and exploration in a safe environment.

• Provide resources for developmental milestones and health screenings.

Safety and injury prevention

•The newly developed locomotion abilities and insatiable curiosity of toddlers make them at risk for injury. 

•Toddlers need close supervision at all times due to their increasing need to explore the environment. The home should be childproofed to prevent injury.

•Risk for poison and choking hazards as well as drowning.

•Poisonings occur frequently because children near 2 years of age are interested in placing any object or substance in their mouths to learn about it. 

•Toddlers are at high risk of drowning due to a lack of awareness of danger and newly developed walking skills. Toddlers can drown in water just deep enough to cover their noses and mouths. Toddlers should not be left unattended near a bathtub, swimming pool, or bucket of water. Use of personal flotation devices and close supervision are required when toddlers are near pools or on boats. 

•Car seat safety: At age 2 years, the child should remain in the back seat but can face forward in a toddler car seat. ​

Nutrition

•Children establish lifelong dietary habits in early childhood. 

•A healthy toddler requires a balanced dietary intake consisting of all five food groups. 

•A variety of nutritious finger foods should be offered at meals and healthy snacks in between meals, and offer a variety of foods as toddlers often develop “food jags” the desire to eat one food repeatedly.

•Avoid small, hard food items such as popcorn, baby carrots, grapes, sliced hot dogs, to decrease risk of aspiration (choking)

•Whole cow’s milk can be consumed at age 1 year but should be changed to low-fat or skim milk at age 2 years. Milk consumption should be limited to 24 ounces daily to prevent decreased appetite and iron-deficiency anemia. ​

Toilet training

•The development of sphincter control occurs between the ages of 18 and 24 months, allowing for toilet training. However, the caregiver should wait until the child expresses interest. Caregivers should practice patience, consistency, and calmness for successful toilet training. ​

Health Promotion for Preschoolers

• Teach safety awareness and the importance of role modeling by caregivers.

• Promote healthy eating habits and the significance of nutrition.

• Discuss the importance of vision screening and early detection of issues.

• Encourage imaginative play and its role in development.

• Provide resources for parents on promoting healthy sleep habits.

• Educate on the importance of regular health check-ups.

Safety and injury prevention

•There is a shift in focus from protection to education. 

•Teach the preschooler how to avoid danger. Teaching pedestrian safety becomes important for preschoolers as exploration continues and their world expands beyond the home.

•Unintentional injury is the leading cause of death in preschoolers. Motor vehicle accidents, suffocation, drowning, and poisoning are the most common injuries leading to death. 

•Preschoolers need to learn about safety and continue to need close supervision. Preschoolers imitate caregiver behavior. For example, caregivers need to wear a bicycle helmet to role model safety behavior for the child.

•Stranger safety: The preschooler must be taught that not all strangers are friendly and safe.

•Car seat: The safest place for a preschooler is in the back seat of the vehicle. Children should remain in a child restraint seat or booster until 4 feet 9 inches tall or until ages 8-12.

Nutrition

•Preschoolers will imitate caregiver behavior. 

•Healthy eating must be role-modeled by the caregiver. Three healthy meals, as well as healthy snacks throughout the day, are necessary to achieve adequate nutrients.

•The quality of the food is more important than quantity in most situations of preschoolers. Preschoolers consume about half of average adult portion sizes. Finicky eating habits are characteristic of the 4-year-old; however, preschoolers engaged in meal preparation are more likely to try new things. The average daily calorie intake is 1800.

Vision screening

•Early detection and treatment of strabismus (when the eyes do not look in the same direction at the same time) must occur by age 6 to prevent amblyopia, often referred to as “lazy eye.”​

Play

•Play is associative (playing with other children but without organization or rules). Imaginative, imitative, and dramatic play are common. Preschoolers begin to prefer the company of peers to caregivers. High-quality TV programming should be limited to 1 hour daily. Age-appropriate activities include large-piece puzzles, pretend and dress-up play, musical toys, painting, drawing, and coloring. ​

•Imaginary playmates are common and help the child distinguish between reality and fantasy. 

Sleep

•Sleep disturbances range from trouble getting to sleep to nightmares to prolonging bedtime with extensive rituals. Frequently children in this playful age-group have had an overabundance of activity and stimulation. 

•Helping them slow down before bedtime usually results in better sleeping habits.

Health Promotion for School-aged Children

• Emphasize the importance of health education and annual health maintenance visits.

• Discuss safety measures, including the use of helmets and seat belts.

• Address childhood obesity and promote healthy eating habits.

• Provide information on screenings for BMI, hearing, and vision.

• Encourage participation in physical activities and sports.

• Educate parents on the importance of monitoring developmental milestones.

Health education during the school-age years is critical to establish behaviors for a healthy adult life.

•Effective health education teaches children about their bodies and how choices, such as nutrition and routine exercise, affect their health. 

•School nurses play a big role in health promotion for this age group. 

•Parents need to recognize the importance of annual health maintenance visits for immunizations, screenings, and dental care.

Safety and injury prevention

•Unintentional injury is the leading cause of death in school-aged children. Developed cognitive and motor skills make unintentional injury less likely than in younger children.​

•Safety teaching is a priority for this age group. They must learn to take responsibility for their own safety by wearing helmets, protective gear, and seat belts. ​

•Car safety: The safest place for a school-aged child is in the back seat of the vehicle. Children should remain in a child restraint seat or booster until 4 feet 9 inches tall or between 8-12 years of age. 

•Children should never ride in the back of a pickup truck. Bicycle and pedestrian safety should be reinforced.

Nutrition

•School-aged children develop eating habits independent of caregiver supervision. 

•Making healthy choices can be difficult, but must be encouraged. Childhood obesity can lead to hypertension, diabetes mellitus, heart disease, and psychological problems. ​ Adequate but not excessive caloric intake is necessary through meals and healthy snacks throughout childhood. 

•Physical exercise is essential for health and wellness. School-aged children need at least 60 minutes of age-appropriate physical activity daily.​

Stress

•Stress is often prevalent for school-aged children, coming from caregiver expectations, peer expectations, the school environment, and violence in the family, school, or community. The healthcare professional can assist the child by identifying potential stressors, teaching coping strategies, and planning interventions to minimize stress.  ​

•Common interventions may include deep breathing, positive imagery, and progressive relaxation. Caregivers and teachers should be involved for maximum success. ​

Screenings

•Important school-aged screenings include height, weight, body mass index, hearing and vision acuity, and scoliosis screening.

•BMI

•Body mass index (BMI) is interpreted differently for children even though it is calculated with the same formula. Due to changes in weight and height with age, BMI levels among children are expressed relative to other children of the same sex and age. After BMI is calculated, it is expressed as a percentile obtained from either a graph or a percentile calculator. The BMI-for-age percentile growth charts are the most commonly used indicator to measure the size and growth patterns of children and teens in the United States.

•Hearing and vision

•Eye shape changes with skeletal growth, which improves vision acuity. Normal adult 20/20 vision is achievable. ​

•Screening for hearing and vision problems is much easier and the results are more reliable because the child understands and can cooperate with testing instructions. Any detected abnormalities should be referred to a healthcare provider for further screening. ​

•Scoliosis

•The American Academy of Pediatrics, as well as other specialty organizations, recommends scoliosis screening for females at age 10 and 12 years, and for males once at age 13 or 14 years