Key Concepts from Conflict Resolution, Erikson's Growth & Development, and Health Promotion
Conflict resolution and chain of command in nursing units
Chain of command and resolution flow
Staff (including lead/charge nurses) are the first point of contact for issues on the unit.
If the staff cannot resolve it, escalate to the manager.
Do not go directly to the president of the college; route through the appropriate supervisor (professor → dean → administrator as outlined).
The manager or administrator will provide guidance and may accompany you to address the issue.
Core idea: know who to go to first, and only escalate when necessary.
Common causes of conflict (general, unit-level)
Stress: rushing, time pressure, feeling overwhelmed.
Communication breakdown: messages not being shared; rumors; misinterpretations; ‘whisper down the lane’ effect.
Unclear expectations: new grads vs. established staff; variability in what is expected at different levels.
Incompatibility with individuals: personality clashes; different working styles.
Diversity factors: age, gender, race, ethnicity differences affecting interaction.
Conflict resolution styles (and their typical use in nursing)
Avoiding/withdrawal: aware of conflict but ignore or postpone resolution; risk of buildup until it erupts.
Smoothing: compliment the other party and focus on agreement to reduce conflict during the process.
Competing: one party wins at the expense of the other; often increases frustration and animosity.
Compromising: both parties give up something of equal value; can work when both sides are willing to concede.
Collaborating: both parties set aside individual goals to achieve a common, mutually agreed-upon goal; requires good communication, shared decision-making, and mutual respect; tends to be the most effective when feasible.
Real-world examples from the transcript
Psychiatric unit conflict between day and night shifts resolved by the nurse manager using a collaborative approach (setting aside differences to determine a common goal).
Self-scheduling discussion: a nurse leader who lets staff self-schedule represents a delegative (laissez-faire) style; often problematic in practice due to uneven coverage and shifting priorities; better approach is a master schedule with input from staff.
“Whisper down the lane” illustrates how miscommunication can escalate conflicts when messages are distorted as they pass through multiple channels.
Practical tips for conflict prevention and resolution
Use the chain of command: address issues with the proper channels first.
Foster open communication and early escalation to prevent buildup.
Strive for collaboration when possible to achieve sustainable resolutions that improve patient care.
When staffing or scheduling issues arise, aim for equity and transparency to minimize perceived unfairness.
Connection to foundational principles
Aligns with patient-centered care: resolving unit conflicts quickly supports safe, high-quality patient care.
Reflects ethical dimensions of leadership: fairness, accountability, and respect for colleagues.
Quick exam-style prompts (to test understanding)
What conflict style is illustrated when staff set aside differences to pursue a shared goal? Answer: Collaborating.
Which leadership style is shown when staff are allowed to make all scheduling decisions? Answer: Laissez-faire/self-scheduling (often less effective in ensuring coverage).
Why is miscommunication particularly dangerous in healthcare units? Answer: It leads to unsafe care, errors, and escalation of conflicts.
Erikson’s psychosocial theory and growth and development in nursing care
Overview of Erikson’s theory
Erikson proposed eight psychosocial stages across the lifespan, each with a central developmental crisis to master.
Each stage has milestones and a psychosocial crisis that can be mastered, delayed, or unresolved, affecting subsequent development.
The theory emphasizes lifelong development and the social context of growth.
The model is contrasted with Piaget’s cognitive focus; ATI materials may emphasize Piaget, while NCLEX content and this lecture emphasize Erikson for psychosocial development.
The eight stages (with typical caregiver/nurse implications)
ext{Trust vs Mistrust: birth--18 months}
Core task: develop sense of trust when caregiver reliably meets needs (feeding, comfort, safety).
Positive outcome: sense of security and trust. Negative outcome: mistrust from inconsistent or unsafe care.
ext{Autonomy vs Shame and Doubt: 1--3 years}
Milestones: independent movement and self-care attempts (toilet training, feeding with minimal assistance).
Positive: autonomy and self-confidence. Negative: shame and doubt from constant criticism or restriction.
ext{Initiative vs Guilt: 4--6 years}
Milestones: exploration, play, initiating activities.
Positive: sense of initiative and purpose. Negative: guilt from overly restrictiveness or punishment.
ext{Industry vs Inferiority: 6--12 years}
Milestones: mastery of academic and social skills; sense of competence.
Positive: industry and achievement; Negative: inferiority if goals aren’t met.
ext{Identity vs Role Confusion: adolescence}
Milestones: developing a coherent sense of self and future direction.
Positive: clear identity; Negative: confusion about role in society.
ext{Intimacy vs Isolation: young adulthood}
Milestones: forming close, committed relationships.
Positive: ability to form lasting relationships; Negative: isolation and loneliness.
ext{Generativity vs Stagnation: middle adulthood}
Milestones: involvement with family, work, community; contributing to the next generation.
Positive: sense of productivity and care for others. Negative: stagnation and self-absorption.
ext{Ego Integrity vs Despair: later adulthood}
Milestones: reflecting on life with a sense of integrity.
Positive: acceptance and readiness for end of life. Negative: despair and regrets.
Nursing care implications by stage (highlights)
Trust/mistrust: provide reliable, consistent care; explain care activities to caregivers; reassure babies and families.
Autonomy: support self-help behaviors (let toddlers choose small options); encourage self-feeding and dressing where appropriate.
Initiative: enable exploration through safe, supervised play and meaningful activities; reinforce positive behaviors with praise.
Industry: involve school-age children in care tasks, celebrate achievements, and support social and academic skills.
Identity: respect privacy and autonomy of teens; involve them in decisions; discuss health choices and risks.
Intimacy: include significant others in education and care planning if patient consents.
Generativity: encourage volunteering and mentoring; support family/community involvement.
Integrity: discuss life review, values, and end-of-life preferences with older adults; respect cultural and spiritual beliefs.
Practical nursing considerations across the lifespan
Use developmentally appropriate communication: play therapy for children, private conversations for teens, respectful dialogue with adults, and dignity-preserving practices for older adults.
Recognize that developmental milestones vary; use baseline assessments and track changes to identify delays or advances.
Provide education tailored to age and cognitive level; for example, use stickers and simple demonstrations with pediatrics (e.g., incentive spirometer with rewards).
Involve families and caregivers in care plans; address caregiver stress and provide access to supports when needed.
Relationship to other foundational theories
Maslow’s hierarchy of needs complements Erikson: as psychosocial needs are met, individuals can progress toward higher-level wellness.
ATI and NCLEX prep expectations vary between Piaget (cognitive development) emphasis and Erikson (psychosocial development); be aware of both when studying.
Nursing actions to support growth and development
Anticipate developmental needs and plan age-appropriate care (neonatal through geriatrics).
Identify and document milestones and potential delays; refer to specialists (speech, occupational therapy, physical therapy) when indicated.
Use developmentally appropriate educational strategies and reinforce learning through age-specific methods.
Engage families in care processes; assess home environment and caregiver capacity; discuss support resources.
For cognitive decline in older adults, allow extra time to respond and use supportive, patient-centered communication; involve loved ones when appropriate.
The health–illness continuum and health promotion
What is health?
Classic definition: health is the state of complete physical, mental, and social well-being, not merely the absence of disease.
Health is also a function of personal values and beliefs; individuals from different cultures/socioeconomic backgrounds may define health differently.
The health-illness continuum describes health as a dynamic state that can move along a spectrum from high wellness to illness, rather than a fixed condition.
Health integrates multiple human dimensions (physical, emotional, intellectual, sociocultural, spiritual).
Factors influencing health and illness
Internal factors: genetics, developmental level, aging.
External factors: environment (pollution, chemicals, housing), lifestyle (nutrition, exercise, stress management), culture, social support.
Stress and anxiety can disrupt health by affecting coping and healthy habits.
Role of the nurse on the health continuum
Identify a patient’s current position on the continuum and anticipate needs to promote wellness.
Promote health by building on strengths, not just treating illness; empower self-care and independence.
Recognize that chronic disease may shift a patient’s baseline over time; continuous monitoring and support are needed.
Health promotion vs illness prevention
Health promotion: behaviors motivated by a desire to increase well-being and health potential.
Illness prevention (disease prevention): behaviors motivated by a desire to avoid or detect disease early.
The three levels of prevention: primary, secondary, tertiary.
Primary prevention and examples
Directly aimed at preventing disease or injury before it occurs.
Examples: vaccinations, immunizations; poison-control education; accident prevention (e.g., teen driver safety); health risk assessments; prenatal counseling; nutrition guidance; smoking cessation support; home safety modifications.
Health risk assessments guide risk reduction strategies (e.g., fall risks in the elderly, housing safety, environmental hazards).
Role of patient education: engage patients in identifying risks and discussing consequences; plan targeted education; involve social work/home care as needed.
Secondary prevention and examples
Focused on early disease detection and prompt intervention to prevent progression.
Examples: routine screenings (blood pressure, dental and vision exams, glaucoma screening, mammograms, prostate and colon cancer screening), early detection of chronic diseases.
Tertiary prevention and examples
Begins after illness is diagnosed and treated; aims to reduce disability and rehabilitation to return to baseline function.
Examples: cardiac rehab after MI, stroke rehabilitation, diabetes management programs, pulmonary rehabilitation for COPD, various post-illness rehab pathways.
Practical implications for nursing practice
Conduct health risk assessments routinely; tailor education and interventions to patient risk profiles.
Emphasize patient education and behavior modification with realistic, small steps (e.g., gradual dietary changes, incremental physical activity).
Coordinate with social workers, home care, and community resources to support ongoing wellness and prevent readmission.
Recognize environmental triggers and lifestyle factors that can worsen conditions (e.g., seasonal allergies, COPD triggers, nutrition in diabetes).
Applying the continuum in patient care
A patient can oscillate along the continuum; wellness and illness are dynamic, not fixed.
Chronic disease patients may have a fluctuating baseline; goal is to improve stability and quality of life rather than cure.
Health education should be practical and manageable; use incremental steps and support systems to promote adherence.
Applying Erikson and the health continuum to practical nursing care across the lifespan
Developmental anticipation and planning
Use milestones to guide care plans and anticipate needs for different age groups.
In pediatrics, align care plans with developmental tasks (trust, autonomy, initiative, industry).
In adults, support identity formation, intimate relationships, and career/parenting roles; in older adults, address integrity, end-of-life concerns, and legacy.
Communication strategies by age group
Infants: rely on caregivers to interpret needs; respond promptly to cries; maintain a predictable routine.
Toddlers/Preschoolers: use simple explanations; offer choices to foster autonomy; involve them in basic care tasks when safe.
School-age children: include them in explanations; provide opportunities to demonstrate understanding; use play and education for learning.
Adolescents: protect privacy; validate feelings; be transparent about health decisions and risks; engage them in goal setting.
Young adults to middle-aged adults: involve partners/families as consented; address work, relationships, and lifestyle choices.
Older adults: allow extra processing time; be mindful of cognitive slowing; support independence while ensuring safety; discuss advanced directives and end-of-life preferences.
Practical nursing care examples
Painful or invasive procedures should be explained at an appropriate level; even if a patient is unresponsive, speak to them and explain what you are doing.
Use AAC or writing boards if a stroke patient cannot speak; provide time for comprehension and response.
For pediatric patients: use age-appropriate teaching aids (stickers, diagrams) and involve family in planning.
For caregivers: assess caregiver burden, provide emotional support, and connect with social work for resources and respite care.
For end-of-life care: maintain privacy, involve family, and respect cultural practices around death and dying.
Connecting theory to practice: Maslow, health promotion, and holistic care
Use Maslow to prioritize basic needs before higher-level goals (safety, nutrition, comfort, belonging).
Integrate health promotion and prevention into care plans, not just disease treatment.
Holistic care considers physical, emotional, cognitive, social, and spiritual dimensions.
Key takeaways and connections to exam-ready concepts
Know the chain of command and the appropriate channels for conflict resolution in clinical settings.
Be able to identify and describe the five conflict-resolution styles and apply them to nursing scenarios, including examiner-style questions.
Understand Erikson’s eight psychosocial stages, their associated developmental tasks, and the nursing actions that support patients at each stage.
Recognize that health is a dynamic continuum influenced by internal/external factors, and that nursing care aims to promote wellness and prevent illness through personalized, developmentally appropriate strategies.
Distinguish primary, secondary, and tertiary prevention with concrete nursing examples and patient education approaches.
Apply developmentally appropriate communication and teaching strategies across the lifespan; involve families and caregivers as appropriate.
Integrate environmental, cultural, genetic, and lifestyle considerations when planning care and health promotion interventions.
Always approach patient education with realistic, incremental changes and support systems to facilitate adherence and long-term wellness.
Use the concepts of responsibility, respect, and collaboration to improve patient outcomes and unit functioning, while acknowledging the realities of workload, scheduling, and interprofessional dynamics.
ext{Note: The transcript emphasizes that ATI materials may emphasize Piaget in some contexts, while NCLEX-style content (and this lecture) centers more on Erikson for psychosocial development.}