1.

Developmental Theories Chapter 11

a. Understanding growth and development helps you to predict, prevent,
and detect any deviations from clients expected patterns
b. It is important to remember that we all have unique patterns of
development
c. The ability to progress through each developmental stage influences
the overall health of each individual
d. Nurses administer care for individuals at various developmental stages
e.
Developmen
tal Theories

Propose ways to account for

how and why people grow as
they do
Provide a framework for
examining, describing, and
appreciating human
development
Helo nurses assess and treat a
patient's response to illness

i. Understanding the specific task or need of each developmental

stage guides caregivers in planning appropriate individualized
care for patients
ii. Theories provide a framework by which to clarify and organize
existing observations to explain and try to predict human
behavior
2. Growth and Development
a. Growth encompasses the physical changes across a persons life span
i. Growth refers to the quantitative changed that nurses measure
and compare with norms
b. Development: A progressive and continuous process of change
i. Begins at conception
ii. Continues throughout a lifetime
1. Development leads to a state of organized and specialized
functional capacity
2. These changes are quantitatively measureable but are
more distinctly measured in qualitative changes
3. You will see both advanced and deterioration
4. A comprehensive view of development includes the
changes that occur during the adult years

5. You are likely to see more changes in younger children as

they grow older
a. Children add inches in height, and we stop growing
taller when we reach a certain age
6. It well be important to track developmental stages,
especially in toddlers
a. If they do not reach certain benchmarks, they may
be suffering from any of a myriad of problems
3. Developmental Processes the developmental phases includes three
processes:
a. Biological processes
i. Physical growth and development
ii. Biological processes produce changes in individual physical
growth and development
iii. Genetic and external influences include nutrition, exercise,
stress, cultures, and sometimes environmental stressors such as
climate
iv. Biological processes include height, weight, changes during
puberty, development of fine motor skills, and sexual maturation
b. Cognitive processes
i. Intelligence, understanding, thinking
ii. These include intelligence, ability to understand and use
language, and the development of thinking that influences an
individuals attitudes, beliefs, and behaviors
c. Socioemotional factors
i. Personality, emotions, relationships with others
4. Biophysical Developmental Theories
a. Examine how bodies grow and change
i. Biophysical developmental theory explores theories of why
individuals age from a biological standpoint, why development
follows a predictiable sequence, and how environmental factors
can influence development
b. Gesells theory of development
i. Arnold Gesell (1880-1961) was a psychologist
1. His categories include motor, language, adaptive, and
personal-social

2. These subgroups are used to achieve a developmental

quotient (DQ) that distinguishes between normal and
abnormal infants
ii. Growth and development is unique and is directed by gene
activity
iii. Maturation follows a fixed developmental sequence
iv. Human growth:
1. Cephalocaudal growth pattern
a. Describes the sequence in which growth is fastest
at the top [head then down]
2. Proximodistal growth pattern
a. Starts at the center of the body and move towards
the extermities
5. Psychoanalytical/Psychosocial Theories
a. Describe development from personality, cognitive, and behavioral
perspectives
b. Explain development as primarily unconscious and influenced by
emotion
c. Psychoanalytical theorists maintain that these unconscious drives
influence development through universal stages experienced by all
individuals
d. Freud vs. Erikson

Developmental
stage/age

Infancy (birth to
18 months)

Early
childhood/toddler
(18 months to 3
years)
Preschool (3 5
years)
Middle childhood
(6 12 years)
Adolescence (12
19 years)

Freud
(Psychosex
ual
developme
nt)
Oral stage
Sucking and
oral
satisfaction
Anal stage

Phallic stage
Latent stage

Genital stage

Erkison (Psychosocial
development)

Trust vs. mistrust

Ability to trust others

Autonomy vs. shame and

doubt
Self-control and
independence
Initiative vs. guilt
Highly imaginative
Industry vs. inferiority
Engaged in tasks and
activities
Identity vs. role confusion
Sexual maturity, Who am
I?

i.
6. Psychoanalytical/Psychosocial Theories: Freud
a. Sigmund Freud believed that the human personality consists of id,
ego, and superego
i. The id (i.e., basic instinctual impulses driven to achieve
pleasure) is the most primitive part of the personality and
originates in the infant
ii. The ego represents the reality component, mediating conflicts
between the environment and the forces of the id
1. The ego helps people judge reality accurately, regulate
impulses, and make good decisions
iii. The superego performs regulating, restraining, and prohibiting
actions
1. Often referred to as the conscience
2. Influenced by the standards of outside social forces (e.g.,
parent, teacher)
b. Freud believed that adult personality is the result of how an individual
resolved conflicts between these sources of pleasure and the
mandates of reality

c. His theory describes a balance between pleasure-seeking drives and

societal pressures
d. These components develop in stages and regulate behavior
e. He identified five stages of development:
i. Stage 1: Oral (birth to 12 to 18 months)
ii. Stage 2: Anal (12 to 18 months to 3 years)
iii. Stage 3: Phallic or Oedipal (3 to 6 years)
iv. Stage 4: Latency (6 to 12 years)
v. Stage 5: Genital (puberty through adulthood)
7. Eriksons Psychosocial Theory
a. Psychosocial theories describe human development from the
perspectives of personality, thinking, and behavior with varying
degrees of influence from internal biological forces and external
societal/cultural forces
b. Erikson maintained that development occurred throughout the
lifespan, and that it focused on psychosocial rather than psychosexual
stages
c. Although Erikson believed that problems in adult life resulted from
unsuccessful resolution of earlier stages, his emphasis on family
relationships and culture offered a broad, lifespan view of development
d. Stages
i. Stage 1: Trust versus mistrust (birth to 1 year)
ii. Stage 2: Autonomy versus shame and doubt (1 to 3 years)
iii. Stage 3: Initiative versus guilt (3 to 6 years)
iv. Stage 4: Industry versus inferiority (6 to 11 years)
v. Stage 5: Identify versus role confusion (puberty)
vi. Stage 6: Intimacy versus isolation (young adult)
vii. Stage 7: Generative versus self-absorption and stagnation
(middle age)
viii. Stage 8: Integrity versus despair (old age)
8. Theories Related to Temperament
a. Temperament is a behavioral style or pattern that affects an
individuals emotional interactions with others
b. Chess and Thomas identified three basic childhood temperaments:

i.

The easy child (easy going and

predictable)
The difficult child (irritable and
irregular)
c.
Knowledge of
The slow-to-warm-up (adapts slowly)
temperament and
how it impacts the parent-child relationship is critical when providing
anticipatory guidance for parents
d. With the birth of a second child, most parents find that the strategies
that worked well with the first child no longer work at all
e. The nurse individualizes counseling to greatly improve the quality of
interactions between parents and children
9. Perspectives on Adult Development
a. Life span perspective: Human development is lifelong, although
changes are slower
i. People continue to develop new abilities and adapt to shifting
environments
ii. Developmental tasks are age-related achievements, the success
of which leads to happiness, whereas failure often leads to
unhappiness, disapproval, and difficulty in achieving later tasks
iii. Contemporary life events approach
1. Part of the Lifespan approach
2. Takes individual variations into account
3. Contemporary theorists proposed theories that support
the need for a balance between the pursuit of active
engagement and selection of activities that support
personal enjoyment for successful aging
iv. Selective optimization with compensation theory states
that as individuals age, they are able to compensate for some
decreases in physical or cognitive performance by developing
new approaches
1. Aging individuals are also able to optimize performance in
some areas through continued practice or the use of new
technology
2. Socioemotional selectivity theory states that as
people age, they become more selective and invest their
energies in meaningful relationships, goals, and activities
a. Current research on successful aging is much more
consistent with a lifespan approach that
emphasizes age-related goals that are relationship

and socially oriented to support continued willbeing

b. Stage-crisis theory Havinghurst (like Erikson) believed that
successful resolution of the developmental task was essential to
successful progression throughout life
i. He identified six stages and ix to ten developmental tasks for
each stage:
1. Infancy and early childhood (birth to 6 years)
2. Middle childhood (6 12 years)
3. Adolescence (13 18 years)
4. Early adulthood (19 30 years)
5. Middle adulthood (30 60 years)
6. Late adulthood (60+ years)
ii. Stage-crisis theory (Havinghurst)
iii. focuses on resolution of tasks:
1. Owing to physical maturation
2. From personal values
3. From societal pressures
iv. Activity theory of older adulthood
1. In response to the view that older adults should gradually
withdraw from society, Havinghurst proposed an activity
theory which states that continuing an active, involved
lifestyle results in greater satisfaction and well-being in
aging
v. Developmental crisis
1. Occurs when a person is having great difficulty meeting
tasks of the current developmental period
10.Cognitive Developmental Theories
a. Cognitive developmental theories examine how people learn to think
and make sense of their world
i. They focus of rational thinking processes, including changes in
how children, adolescence, and adults perform intellectual
operations
b. Jean Piaget

i. A Swiss biologist and philosopher interested in the development

of childrens intellectual organization in other words, how they
think, reason, and perceive their world
ii. He believed that individuals move from one stage to another
seeking cognitive equilibrium or a state of mental balance
1. Play is important to a childs development
iii. Four stages:
1. Period I: Sensorimotor (birth to 2 years)
2. Period II: Preoperational (2 to 7 years)
3. Period III: Concrete operations (7 to 11 years)
4. Period IV: Formal operations (11 years to adulthood)
iv. Postformal thought (a fifth stage)
1. Developmentalists proposed a 5th stage of cognitive
development termed postformal though
2. Within this stage, adults demonstrate the ability to
recognize that answers vary from situation to situation
and that solutions need to be sensible
v. Continued cognitive development involves increasing cognitive
flexibility.
vi. Adults change how they use knowledge, and the emphasis shifts
from attaining knowledge or skills to using knowledge for goal
achievement.
vii. Assessment of cognitive ability becomes critical as the nurse
engages in health care teaching for patients and families.
11.Moral Developmental Theory
a. Attempts to define how moral reasoning matures for an individual
b. It encompasses both interpersonal and intrapersonal dimensions as it
governs how we interact with others
c. Refers to changes in a persons thoughts, emotions, and behaviors that
influence the perception of right or wrong
d. Kohlbergs moral developmental theory (he expanded on Piagets
work)
i. Moral reasoning develops in stages
ii. Six stages in three levels
12.Kohlbergs Moral Developmental Theory

a. Level I: Preconventional reasoning, when children ask WHY.

i. Stage 1 = Punishment and Obedience Orientation: Children view
illness as a punishment
1. Avoiding punishment or the unquestioning deference to
authority is characteristic motivation to behave
2. Physical consequences guide right and wrong choices
a. If the child is caught, it must be wrong
b. If he or she escapes, it must be right
ii. Stage 2 = Instrumental Relativist Orientation
1. The child recognizes that there is more than one right
view
a. The decision to do something morally right is based
of satisfying ones own needs and occasionally the
needs of others
b. The child perceives punishment not as proof of
being wrong (as in Stage 1) but as something that
one wants to avoid
iii. Level I is the premoral level in which cognitive thinking is limited
and the individualss thinking is primarily egocentric
1. At this stage, thinking is mostly based of likes and
pleasures
2. This stage progresses toward having punishment guide
behavior
iv. Nurses need to be aware of this egocentric thinking and must
reinforce that the child does not become ill because of
wrongdoing
b. Level II: Conventional reasoning, when moral reasoning is based on
internalization of societal and others expectations
i. Stage 3 = Good Boy-Nice Girl Orientation
1. The individual wants to win approval and maintain the
expectations of ones immediate group
ii. Stage 4 = Society-Maintaining Orientation
1. Individuals expand their focus from a relationship with
others to societal concerns during Stage 4
2. Moral decisions take into account societal perspectives

3. Right behavior is doing ones duty, showing respect for

authority, and maintaining the social order
iii. Moral decision making at this level moves from, Whats in it for
me? to How will it affect my relationship with others?
iv. Emphasis now is on social rules and community-centered
approach
v. Nurses observe this when family members make end-of-life
decisions for their loved ones
c. Level III: Postconventional reasoning occurs when a person finds a
balance between basic human rights and obligations and societal rules
and regulations.
i. Stage 5 = Social Contract Orientation
1. An individual follows the societal law but recognizes the
possibility of changing the law to improve society
2. The individual also recognizes that different social groups
have different values but believes that all rational people
would agree on basic rights such as liberty and life
3. Individuals at this stage make more of an independent
effort to determine what society should value rather than
what society as a group would value (the latter would
occur in stage 4)
4. The U.S. Constitution is based on this morality
ii. Stage 6 = Universal Ethical Principle Orientation, where right is
defined by the decision of conscience in accord with self-chosen
ethical principles
1. Self-chosen ethical principles are abstract, such as the
Golden Rule, and appeal to logical comprehensiveness,
universality, and consistency
2. For example, the principle of justice requires that the
individual treat everyone in an impartial manner,
respecting the basic dignity of all people, and guides the
individual to base decisions on an equal respect for all
3. Civil disobedience is one way to distinguish Stage 5 from
Stage 6
4. Stage 5 emphasizes basic rights, the democratic process,
and following laws without question, whereas Stage 6
defines the principles by which agreements will be most
just

5. For example, a person in Stage 5 follows a law, even if its

not fair, but a person in Stage 6 does not
iii. Individuals move away from moral decisions based on authority
or conformity to groups to define their own values and principles
iv. Individuals at this level start to look at what and ideal society
would be like
13.Moral Reasoning and Nursing Practice
a. Moral development attempts to define how moral reasoning matures
for each individual
b. It is also important to recognize the level of moral reasoning used by
other members of the health care team and its influence on a patients
care plan
i. Ideally all members of the health care team are on the same
level, creating a unified outcome
c. Nurses need to identify their own moral reasoning.
d. Nurses need to recognize the level of moral reasoning used by other
health care team members.
e. Nurses need to separate their own beliefs when helping patients with
their moral decision-making process.
14.Perspectives
a. No one theory can describe how people grow and develop
i. From the diverse set of theories included in this chapter, the
complexity of human development is evident
b. Developmental theories help nurses to use critical thinking skills
i. Todays nurse needs to be knowledgeable about several
theoretical perspectives when working with patients
ii. Your assessment of a patient required a thorough analysis and
interpretation of data to form accurate conclusions about his or
her developmental needs
iii. The theories serve as important guidelines for understanding
important human processes that allow nurses to predict human
responses and to recognize deviations from the norm
c. Examples of nursing diagnoses applicable to patients with
developmental problems include:
i. Risk for delayed development
ii. Delayed growth and development

iii. Risk for disproportionate growth

Case Study
o Ahmad is learning about Freuds developmental theories.
o Rank in their correct order the following stages of psychosocial
development as determined in Freuds psychoanalytical model of
personality development:
Genital
Anal
Oral
Phallic
Latency
o Answer:
Oral
Anal
Phallic
Latency
Genital
Case Study (contd)
o Ahmad is studying Gesells theory of development.
o True or False: According to Gesells theory of development, each
childs pattern of growth is a result of environmental influences.
o Answer: False.
Rationale: According to Gesells theory of development, each
childs pattern of growth is directed by gene activity, not by
environmental factors.

Case Study (contd)

Ahmad is learning that psychoanalytical theorists varied greatly in their

perceptions related to development.
o

Which psychoanalytical theorist believed that development occurred

throughout the life span and focused on psychosocial stages?

Piaget

Freud

Erikson

Chess

Answer: Erikson

Rationale: Erik Erikson believed that development occurred

throughout the life span and that it focused on psychosocial
stages rather than psychosexual stages.

Quick Quiz!

According to Kohlberg, moral development is a component of psychosocial

development. Moral development depends on the childs ability to integrate
o Modeling of others.
o Faith and optimism.
o Self-control and independence.
o Decisions of right and wrong.
o Answer: D