Growth And Development
Throughout your nursing training and career, you will care for patients and family members of all ages. It is important to have an understanding of where they are from both a developmental and a cognitive perspective. This will enhance your interactions and decrease frustration on both sides.
Many believe that they are just memorizing this for a NCLEX-RN test, but I assure you that this is knowledge that you will use every shift.
Think about the following examples for a moment:
Using the same approach with each patient would not successful, you must stop and think about where the individual is at and meet them on that same level. Review the Charts below for examples of where you would expect the individual to be.
Erickson’s Psychosocial Theory
|Stage||Name||Age||Psychosocial Crisis||Positive Outcome||Negative Outcome|
|1||Infancy||Day 1 to 1.5 years||Trust vs. Mistrust||Feelings of Trust||Fear or mistrust|
|2||Early Childhood||1.5 to 3 years||Autonomy vs. Shame and Doubt||Self Sufficiency||Lack of independence|
|3||Play Age||3 to 5 years||Initiative vs Guilt||Discovers ways to initiate actions||Guilt from actions or thoughts|
|4||School Age||5 to 12 years||Industry vs Inferiority||Development of sense of competence||No sense of mastery|
|5||Adolescence||12 to 18 years||Identity vs Role Confusion||Awareness of uniqueness of self||Inability to identify the appropriate roles of life|
|6||Young Adult||12 to 18 years||Intimacy vs Isolation||Development of loving, sexual relationships||Fear of relationships with others|
|7||Middle Adult||25 to 65 years||Generative vs Stagnation||Sense of contribution to continuity of life||Feeling one's activities are trivial|
|8||Late Adult||65+ Years||Ego Integrity vs Despair||Sense of unity in life's achievements||Regret over lost opportunities of life|
Mastering these tasks plays a huge role in the development of an individual. Failure to master a task can lead to issues at later stages in life. During stressful time, such as a serious illness or loss, an individual may regress, and as caregivers we should be aware of this and aid them in proceeding forward as they are able.
Thinking of some of the earlier examples, a one month old requires no explanation of the immunization but does require nurturing during and immediately after wards to ensure the development of trust. The ten year old, on the other hand, should be provided with basic and honest information before the procedure and perhaps simple options of which arm should be used and if he or she wishes to hold a parent’s hand.
When discussing life goals, expect very different responses. For example, a four year old may desire to be a princess, a 20 year old may be struggling with all the potential options and obstacles, and the 70 year old may be focused on enjoying his remaining years by traveling.
Piaget’s Four Stages of Cognitive Developmentally
|Sensorimotor||Birth to 2 years||Begins to differentiate self from objects
Interacts with the environment
Object permanence and separation anxiety develop
|Pre-Operational||2 to 7 years||Learns to use symbols (words and images)
Thinking is egocentric - cannot see viewpoint of others
|Concrete Operational||7 to 11 years||Can think logically about objects and events
Classifies objects according to several features
|Formal Operational||11 years and up||Can think logically about abstract propositions and test hypotheses systematically
Becomes concerned with the hypothetical, future, and ideological problems
Every child develops at their own pace, but having a basic understanding of where he or she is helps the provider develop a strong therapeutic relationship with the patient. The stronger the bond, the more open and honest the patient will be. This will allow you to discuss their fears and concerns which in the end will allow you to provide them with the highest level of care.