I. Developmental Concepts

I. Developmental Concepts

Kaitlyn Louis MSN, RN

Learning Objectives:

  • Summarize basic principles of growth and development.

  • Identify the impact of genetics, genomics, and epigenetics on growth and development.

  • Discuss the theories of Freud, Erikson, 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.

  • Explain implications for nursing practice based on an understanding of growth and development.

II. Growth & Development

Definitions:

  • Growth: An increase in body size or changes in body cell structure, function, and complexity.

  • Development: An orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning.

Key Aspects:

  • Humans grow and develop in many ways: physical, cognitive, psychosocial, moral, and spiritual.

  • Nurses promote health across the lifespan.

  • Typical growth and development characteristics must be understood to give individualized and holistic care.

III. Principles of Growth & Development

  • Growth and development are orderly and sequential, as well as continuous and complex.

  • Growth and development follow regular and predictable trends.

  • Growth and development are both differentiated and integrated.

  • Different aspects of growth and development occur at different stages and at different rates, and can be modified.

  • The pace of growth and development is specific for each person.

IV. Factors Impacting Growth & Development

Individual Factors:

  • Maternal age

  • Inadequate fetal care

  • Maternal substance use

Genetics:

  • Every human receives an equal number of chromosomes from each parent.

  • Physical characteristics are inherited from our family of origin.

  • Genetics can influence the development of diseases.

  • Heredity: The transmission of genetics, what is passed down and inherited from generation to generation.

  • Genome: The complete set of DNA in an organism, including all its genes.

Environmental Factors:

  • Congenital disorders

  • Brain damage related to accidents or abuse

  • Chronic illness

  • Poverty

Nutrition:

  • Inadequate nutrition

  • Environment and nutrition influence all stages of development.

  • Environmental and nutritional effects can occur independently but are often linked.

Psychosocial Experiences

Caregiver Factors:

  • Neglect or abuse

  • Mental illness

  • Learning disabilities

V. Developmental Theories

  • Aim at explaining certain human responses.

  • Each theory has a different focus.

  • Cognitive, social, and instinctual influences.

VI. Theory of Psychoanalytic Development (Sigmund Freud)

  • Emphasizes the effect of instinctual human drives on behavior.

  • Sexuality – the underlying drive.

4 Major Components of the Mind:

  • Unconscious mind

  • Id

  • Defense mechanisms

  • Ego

5 Stages of Development:

  • Oral stage (0 - 18 months):
    Eating, biting, chewing, sucking

  • Anal stage (18 months – 3 years):
    Toilet training

  • Phallic stage (3 years – 7 years):
    Awareness of sex differences
    Oedipus complex & Electra complex

  • Latency Stage (7 years – 12 years):
    Transition to adolescence

  • Genital Stage (12 years – 20 years):
    Overt relationships
    Social considerations

VII. Theory of Cognitive Development (Jean Piaget)

  • Learning occurs as a result of internal organization of an event → mental schema.

  • Growth comes from a constant restructuring of knowledge to progress to higher levels of problem-solving & critical thinking.

  • Assimilation

  • Accommodation

4 Stages of Cognitive Development:

  • Sensorimotor stage (birth – 2 or 3 years)

  • Preoperational stage (2 or 3 years – 6 or 7 years)

  • Concrete Operational stage (6 or 7 years – 11 or 12 years)

  • Formal Operational stage (11 or 12 years – 14 or 15 years)

Piaget’s Stages Video

VIII. Theories of Psychosocial Development

  • Erikson

  • Gould

  • Levinson

IX. Theory of Psychosocial Development (Erik Erikson)

  • Based on 4 major organizing concepts:

    • Stages of development

    • Developmental tasks

    • Psychosocial crises

    • Process of coping

  • Development is a continuous process made up of distinct stages.

  • Stages = the achievement of developmental goals.

  • Failure to succeed in developmental goals may delay progress.

8 Stages from Birth – Death:

  1. Trust vs. Mistrust (infant)
    Rely on caregivers to meet needs; mistrust can develop from inconsistent/inadequate care

  2. Autonomy vs. Shame & Doubt (toddler)
    Learning from the environment & gaining independence

  3. Initiative vs. Guilt (Preschool)
    Seeks out new experiences & explores the how and why of the world

  4. Industry vs. Inferiority (School-Age)
    Pleasure gained from finishing projects & getting recognition for doing so

  5. Identity vs. Role Confusion (Adolescence)
    Hormonal changes, mood swings, roles & rebellious behaviors, sense of self

  6. Intimacy vs. Isolation (Young Adulthood)
    Unite self-identity with identities of others, make commitments and connections

  7. Generativity vs. Stagnation (Middle Adulthood)
    Involvement with friends, family, and community, becoming concerned for future generations

  8. Ego Integrity vs. Despair (Late Adulthood)
    Reminiscence of life events, possible fear of dying, evaluating their contributions

Erikson’s Stages - Video

X. Theory of Psychosocial Development (Roger Gould)

  • Studied ages 16-60.

  • Central theme for the adult years is transformation, with specific beliefs & developmental tasks.

6 Age-Related Stages:

  • Ages 18-22: Leaving the Parent’s World
    Adjust to / transition to living on their own

  • Ages 22-28: Getting into the Adult World
    Want to demonstrate independence & confidence, plan for the future

  • Ages 29-34: Questioning & Reexamination
    Self-acceptance increases, marriage & careers well established, accepting of children

  • Ages 35-43: Midlife Decade
    Introspection—questioning values & beliefs, feelings of having little time left, may be critical of parents

  • Ages 43-50: Reconciliation & Mellowing
    Belief that personalities are set, understanding of personal lifespan, active social life, feelings of loss of control may lead to depression

  • Ages 50+: Stability & Acceptance
    Increased self-approval and self-acceptance, increased marital happiness

XI. Theory of Psychosocial Development (Daniel Levinson)

  • Based on the concept of “the evolution of individual life structure”.

  • The self

  • The social & cultural aspects

  • The person’s roles

  • When anything changes with one component, the whole life structure must reorganize.

3 Major Phases in Young & Middle Adult Life:

  1. Novice:

    • Early Adult Transition (17-22): Initial career choices, break away from parents, select values & establish goals

    • Entering the Adult World (22-28): Try different careers & lifestyles, build on previous decisions & choices

    • Age 30 Transition: Evaluate established place in the world and what’s been accomplished

  2. Settling Down (33-40):
    Build adult life structure—family, work, community; strives to gain respect

  3. Midlife Transition (40-50):

    • Transitioning into Middle Adulthood (40-45): Reappraisal of goals and values, lifestyle may continue or change, fear/anxiety

    • Entering Middle Adulthood (45-50): New choices and life structure, committing to new tasks

XII. Theories of Moral Development

  • Kohlberg

  • Gilligan

XIII. Theory of Moral Development (Lawrence Kohlberg)

  • “A person’s moral development is influenced by cultural effects on the person’s perceptions of justice in interpersonal relationships.”

  • Begins in early childhood, develops through adolescence into adulthood.

  • Morality: A subset of beliefs or values that governs choices made throughout life.

  • A person will either accept or reject societal rules.

Preconventional Level – Based on External Control:

  • Stage 1: Punishment & Obedience
    Oriented to obedience and punishment; right and wrong defined by punishments

  • Stage 2: Instrumental Relativist
    Acts that are satisfying to self and some satisfying to others are considered “right”

Conventional Level – Conforming to Expectations:

  • Stage 3: Interpersonal Concordance
    Maintaining good relationships, "good-girl & good-boy" behavior, approval seeking

  • Stage 4: Law and Order
    Behavior follows rules, duty to society, respect for authority

Post-Conventional Level – Rational, Internal Moral Judgement:

  • Stage 5: Social Contract
    Personal values define right/wrong; may reject unjust laws

  • Stage 6: Universal Ethical Principle
    Equality and justice for all; moral principles over laws; few reach this stage

XIV. Theory of Moral Development (Carol Gilligan)

  • Felt female perspective wasn’t reflected in Kohlberg’s work.

  • Girls & women: response and care

  • Boys & men: justice

  • Ethic of care: Women’s moral orientation

3 Levels:

  • Level 1 – Preconventional: Selfishness
    Focused on own needs, disappointing relationships, no separation between should and would

  • Level 2 – Conventional: Goodness
    Societal norms accepted, care for others

  • Level 3 – Post-Conventional: Nonviolence
    Not hurting others is priority, care is universal, moral focus on relationships

XV. Theory of Faith Development (James Fowler)

  • Based on Piaget, Kohlberg, & Erikson

  • Faith is more than religion; it’s about meaning and purpose

  • Pre-stage + 6 stages; equilibrium can occur at any stage from Stage 2+

Pre-stage: Undifferentiated Faith

  • Trust, courage, hope, and love vs. abandonment

  • Faith based on relationship with caregiver

Stages:

  • Stage 1: Intuitive-Projective Faith
    Imitation, imagination, minimal understanding

  • Stage 2: Mythical-Literal Faith
    Social interaction, fairness, acceptance of deity

  • Stage 3: Synthetic-Conventional Faith
    Identity development, questioning values/religion

  • Stage 4: Individuative-Reflective Faith
    Self-identity, personal beliefs/responsibility

  • Stage 5: Conjunctive Faith
    Understand one's beliefs and others’ differences

  • Stage 6: Universalizing Faith
    Love and justice for all humanity

XVI. Application to Nursing Care

  • Be knowledgeable.

  • Maintain flexibility.

  • Respect the uniqueness of each person.

  • Anticipate possible regression.

  • Understand environmental and cultural influences.

  • Recognize that individuals may show behaviors from previous, current, and upcoming stages.

  • Family can influence a patient’s growth & development.

  • Promote developmentally challenging environments.

  • Collaborate with the health care team.

XVII. Credits

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