8 Sciene

Human Growth and

Development
CHAPTER
OBJECTIVES
After completing this chapter, you should
be able to:
Identify at least two physical, mental, emotional, and social developments that occur
during each of the seven main life stages
Explain the causes and treatments for eating disorders and
chemical abuse
Identify methods used to prevent suicide and list common
warning signs
Recognize ways that life stages affect an
individual's needs
• Describe the five stages of grieving that occur in the dying patient and the role of the
health care worker during each stage
List two purposes of hospice care and provide justifications
for the "right to die"
• Create examples for each of Maslow's
Hierarchy of Needs
Name the two main methods people use to meet or
satisfy needs
 Describe a situation that shows the use of each of the following defense mechanisms:
rationalization, projection, displacement, compensation, daydreaming, repression,
suppression, denial, and withdrawal
Define, pronounce, and spell all
key terms

KEY
TERMS
acceptanc
e
bulimarexia
developmen
t

adolescence
(byou-lee"-mah-rex'-ee-
ah)
displaceme
nt
affection
bulimia (byou-lee'-
me-ah)
early
adulthood
Alzheimer's
disease
chemical abuse
early
childhood
(Altz'-high-
merz)
anger

anorexia nervosa (an-oh-

rex'-
see-ah ner-voh'-
sah)
cognitiv
e
emotional

compensatio
 n
esteem
(cahm"-pen-say'-
shun)
nove
growth
daydreami
ng
hospice (hoss'-
pis)
arteriosclerosis
defense mechanisms

(ar-tear"-ee-oh-skleh-row'-
sis)
denial
infanc
y
late adulthood
bargaini
ng
depressi
on

228
1

KEY TERMS
(CONT.)
late childhood

life
stages
mental
projecti
on
puberty (pew"-burr' -
tee)
rationalization
HUMAN GROWTH AND DEVELOPMENT
229
 middle adulthood
(rash"-en-nal-ih-zay'-
shun)
motivated
regressi
on

needs
repressi
on

physic
al
right to
die

physiological
needs
(fizz"-ee-oh-lodg'-
ih-kal)
safet
y
satisfaction
self-actualization

sexuali
ty
social

suicide

suppressio
n
tension

terminal illness

withdrawal

Introductio
n

Human growth and development is a process

that begins at birth and does not end until death. Growth refers
to the measurable physical changes that occur
throughout a person's life. Examples include height,
weight, body shape, head circumference, physical
characteristics, development of sexual organs, and
dentition (dental structure). Development refers to
the changes in intel- lectual, mental, emotional, social, and
functional skills that occur over time. Development is more
difficult to measure, but usually proceeds from simple to
com- plex tasks as maturation, or the process of
becoming fully grown and developed, occurs. During
all stages of growth and development, individuals have
certain tasks that must be accomplished and needs that
must be met. A health care worker must be aware of the various life
stages and of individual needs to provide quality health
care (Figure 8-1).

8:1 Life
Stages
Even though individuals differ greatly, each
person passes through certain stages of growth and
development from birth to death. These stages are
frequently called life stages. A common method of
classifying life stages is as follows:

Infancy: birth to 1
year
·

Early childhood: 1-6

years
Late childhood: 6-12 years

. Adolescence: 12-18 years

Early adulthood: 19-40

years
Middle adulthood: 40-65 years

Late adulthood: 65 years and older

As individuals pass through these life stages, four main types of growth and development occur: physical,
mental or cognitive, emotional, and social. Physical
refers
 FIGURE 8-1 An understanding of life stages is important for the health care worker, who may provide
care to individuals of all ages; from
the very young (left) to the elderly (right). Andrew
Gentry/www.Shutterstock.com and michaeljung/www.Shutterstock.com
23
0
CHAPTER 8
1

to body growth and includes height and weight

changes, muscle and nerve development, and
changes in body or- gans. Mental or cognitive refers
to intellectual develop- ment and includes learning how to
solve judgments, and deal with
problems, make
situations. Emotional refers to feelings and
includes dealing with love, hate, joy, fear, excitement,
and other similar feelings. Social refers to in- teractions
and relationships with other people.
Each stage of growth and development has its
own characteristics and has specific developmental
tasks that an individual must master. These tasks
progress from the simple to the more complex. For
example, an individual first learns to sit, then crawl, then
stand, then walk, and then, finally, run. Each stage
establishes the foundation for the next stage. In this
way, growth and development pro- ceeds in an
orderly pattern. It is important to remember,

TABLE 8-1 Erikson's Eight Stages of Psychosocial

Development

Stage of
Developme
nt
Basic Conflict

Infan
cy
Trust
versus
Mistrust
Birth to 1
Year Oral-
Sensory
Major Life
Event

Feedin
 g

Autonomy versus Toilet

Training
Shame/Doubt
Toddler
1-3 Years
Muscular-Anal

Preschool

3-6 Years
Locomotor
Initiative
versus
Guil
t
Independen
ce

School-
Age
6-12 Years
Latency

Adolescence
12-18 Years
Industry versus School
Inferiorit
y

Identity
versus
Role
Confusion
Peer
however, that the rate of progress varies among individu- als.
Some children master speech early, others master it later.
Similarly, an individual may experience a sudden growth
spurt and then maintain the same height for a period
of time.
Erik Erikson, a psychoanalyst, has identified eight stages of psychosocial development. His eight stages of
 de- velopment, the basic conflict or need that must be
resolved at each stage, and ways to resolve the conflict
are shown in Table 8-1. Erikson believes that if an individual is not
able to resolve a conflict at the appropriate stage, the
individual will struggle with the same conflict later
in life. For example, if a toddler is not allowed to learn
and become independent by mastering basic tasks, the
toddler may develop a sense of doubt in his or her abilities.
This sense of doubt will inter- fere with later attempts at
mastering independence.

Ways to Resolve
Conflict
Infant develops trust in self, others, and the environment when
caregiver is responsive to basic needs and provides comfort; if
needs are not met, infant becomes uncooperative and
aggressive, and shows a decreased interest in the environment

Toddler learns control while mastering skills such as feeding,

toileting, and dressing when caregivers provide reassurance but
avoid overprotection; if needs are not met, toddler feels ashamed and
doubts own abilities, which leads to lack of self-confidence in later
stages

Child begins to initiate activities in place of just imitating

activities; uses imagination to play; learns what is allowed and
what is not allowed while beginning to develop a conscience;
caregivers must allow child to be responsible while providing
reassurance; if needs are not met, child feels guilty and thinks
everything he or she does is wrong, which leads to a hesitancy
to try new tasks in later stages

Child becomes productive by mastering learning and obtaining

success;
child learns to deal with academics, group activities, and friends when at others show acceptance of actions
and praise success; if needs are
not met, child develops a sense of inferiority and
incompetence, which hinders future relationships and the
ability to deal with life events

Adolescent searches for self-identity by making choices about

occupation,
sexual orientation, lifestyle, and adult role; relies on peer
group for support and reassurance to create a self-image
separate from parents; if needs are not met, adolescent experiences
role confusion and loss of self-belief Young
adult learns to make
a personal commitment to others and
Relationshi
ps
Young
 Adulthood 19-
40 Years
Intimacy versus Love
Isolatio
n

Middle Adulthood
Generativity
Parentin
g
40-65 Years
versus

Stagnati
on
Older Adulthood
Ego
Integrity
65 Years to Death
versus

Despa
ir
of Life
Reflection on
and
Acceptance
share life events with others; if self-identity is lacking, adult
may fear relationships and isolate self from others
Adult seeks satisfaction and obtains success in life by using
career, family, and civic interests to provide for others and the
next generation; if adult does not deal with life issues, feels lack of
purpose to life and sense of failure
Adult reflects on life in a positive manner, feels fulfillment with his
or her own life and accomplishments, deals with losses, and
prepares for death; if fulfillment is not felt, adult feels despair
about life and fear of death
Copyright©Cengage Learning® All
Rights Reserved
Jean Piaget, a developmental biologist,
identified cognitive stages of development based on
how an or- ganism adapts to its environment. His
basic concept is that infants are born with reflexes that the infant uses
toadapt to the environment. Through assimilation, a
pro- cess by which a person's mind takes in
information from the environment, and accommodation,
the process of changing cognitive ideas based on the
new information, the person learns to maintain
equilibrium, or a balance with the environment.
Piaget's four stages of cognitive development are
shown in Table 8-2. During each level,
TABLE 8-2 Piaget's Four Stages of Cognitive
Development
Stage
Characteristic Behavior
Sensorimotor Initially uses simple reflexes
such as
(Birth
to 2
years)

Preoperatio
nal (2 to 7
years)

Concrete
Operational
(7 to 11
years)

Forma
l
Operational
(Above 11
years)
sucking and grasping Recognizes self as
causing an action and repeats
action intentionally Begins to
understand that objects are
 permanent even when they can't
be seen
Explores new possibilities and
discovers
ways to get different results
Begins to recognize cause
and effect
relationship
s

Begins to use words and

images to
represent
objects
Tends to be egocentric (self-
centered) Classifies objects in
simple ways, such as
shape, color, or important features Reacts to all
similar objects as though
they are
identical
By age 4, begins to understand
concepts
but has limited
logic
By age 6 to 7, understands the
difference
between reality and
fantasy
Egocentrism decreases and
speech
becomes more socialized

Thinks logically about events,

objects, and
the environment
Still experiences difficulty with
abstract or
hypothetical
concepts
Understands reversibility, or an
ability to
retrace mental steps to solve problems Classifies
objects and can position them in
a series based on specific features
Thinks logically about abstract
propositions
and hypotheses to solve problems
Becomes less dependent on
concrete reality
 and is able to reason contrary to facts
Develops ability to become
concerned with
ideological problems and
the future
Copyright©Cengage Learning® All Rights
Reserved
HUMAN GROWTH AND DEVELOPMENT
231

Piaget believes new abilities are learned that prepare the individual for the next level.
Health care providers must understand that each life stage creates certain needs in individuals. Likewise, other
factors can affect life stages and needs. An individ-
ual's sex; race; heredity (factors inherited from parents,
such as hair color and body structure); culture; life
expe- riences; and health status can influence needs.
Injury or illness usually has a negative effect and can
change needs or impair development.

Infany
PHYSICAL DEVELOPMENT
The most dramatic and rapid changes in growth and
development occur during the first year of life. A new-
born baby usually weighs approximately 6-8 pounds (2.7-
3.6 kg) and measures 18-22 inches (46-55 cm) (Figure 8-2).
By the end of the first year of life, weight has usually
tripled, to 21-24 pounds (9.5 -- 11 kg), and height has
increased to approximately 29-30 inches (74-76 cm).
Muscular system and nervous system developments are also dramatic. The muscular and nervous systems are very
immature at birth. Certain reflex actions pres- ent at
birth allow the infant to respond to the environ- ment. These
include the Moro, or startle, reflex to a loud noise or sudden
movement; the rooting reflex, in which a slight touch on the
cheek causes the mouth to open and the head to turn; the
sucking reflex, caused by a slight touch on the lips; and
the grasp reflex, in which in- fants can grasp an object
placed in the hand (Figure 8-3). Muscle coordination
develops in stages. At first, infants are able to lift the
head slightly. By 2-4 months, they can usually roll from
side to back, support themselves on their forearms
when prone, and grasp or try to reach ob- jects.
By 4-6 months, they can turn the body completely
FIGURE 8-2 A newborn baby usually weighs approximately
6-8 pounds and measures 18-22 inches in length.
Philip
Lange/www.Shutterstock.co
m
232
CHAPTER 8
6

(A
)
(B)

(C)
(D
)

FIGURE 8-3 Some reflex actions an infant has at birth include (A) rooting, (B) sucking, (C) grasp, and
(D) Moro. Copyright © Cengage Learning®. All Rights Reserved

around, accept objects handed to them, grasp

station- ary objects such as a bottle, and with support,
hold the head up while sitting. By 6-8 months, infants
can sit unsupported, grasp moving objects, transfer
objects from one hand to the other, and crawl on the stomach.
By 8-10 months, they can crawl using their knees
and hands, pull themselves to a sitting or standing
position, and use good hand-mouth coordination to put
things in their mouths. By 12 months, infants
frequently can walk without assistance, grasp objects
with the thumb and fingers, and throw small objects.
Other physical developments are also dramatic.
Most infants are born without teeth, but usually have
10-12 teeth by the end of the first year of life. At birth,
vision is poor and may be limited to black and white,
and eye movements are not coordinated. By 1 year
o
however, close vision is good, in color, and can
f age,
read- ily focus on small objects. Sensory abilities
such as those
of smell, taste, sensitivity to hot and cold, and
hearing, while good at birth, become more refined
and exact.

MENTAL DEVELOPMENT
Mental development is also rapid during the first year. Newborns respond to discomforts such as pain,
cold, or hunger by crying. As their needs are met,
they gradu- ally become more aware of their
surroundings and begin to recognize individuals
associated with their care. As infants respond to
stimuli in the environment, learn- ing activities grow.
At birth, they are unable to speak. By 2-4 months,
they coo or babble when spoken to, laugh out loud,
and squeal with pleasure. By 6 months of age,
infants understand some words and can make ba- sic
sounds, such as "mama" and "dada.” By 12 months,
infants understand many words and use single
words in their vocabularies.
EMOTIONAL DEVELOPMENT

Emotional development is observed early in life.

New- borns show excitement. By 4-6 months of age,
delight, anger, disgust, and fear can often
distress,
be seen. By 12 months of age, elation and affection
for adults is evident. Events that occur in the first year of
life when these emotions are first exhibited can have
a strong in- fluence on an individual's emotional
behavior during adulthood.

SOCIAL DEVELOPMENT

Social development progresses gradually from the

self- centeredness concept of the newborn to the
recognition of others in the environment. By 4 months
of age, in- fants recognize their caregivers, smile
readily, and stare intently at others (Figure 8-4). By
6 months of age, in- fants watch the activities of
others, show signs of posses- siveness, and may
become shy or withdraw when in the presence of
strangers. By 12 months of age, infants may still be
shy with strangers, but they socialize freely with
familiar people, and mimic and imitate gestures, facial
expressions, and vocal sounds.

NEEDS AND CARE

Infants are dependent on others for all needs. Food,

cleanliness, and rest are essential for physical
growth. Love and security are essential for
emotional and social growth. Stimulation is essential
for mental growth.
While caring for infants, a health care provider
should give the parents or guardians support and
reas- surance and involve them in the infant's care.
Providing information on nutrition, growth,
development, sleep patterns, meeting needs, and
creating a healthy environ- ment will promote wellness
in the infant. Care must betaken at all times to
ensure the infant's safety. Preventing
HUMAN GROWTH AND
DEVELOPMENT 233

the transmission of infection by washing hands thor-

oughly and observing standard precautions is also es-
sential during care.

Early
Childhood
PHYSICAL DEVELOPMENT

During early childhood, from 1-6 years of age,

physi- cal growth is slower than during infancy. By
age 6, the average weight is 45 pounds (20.4 kg), and
the aver- age height is 46 inches (116 cm). Skeletal
and muscle development helps the child assume a
more adult ap- pearance. The legs and lower body
tend to grow more rapidly than do the head, arms,
and chest. Muscle coor- dination allows the child to
run, climb, and move freely. As muscles of the fingers
develop, the child learns to write, draw, and use a fork
and knife. By age 2 or 3, most primary teeth have
erupted, and the digestive system is mature enough
to handle most adult foods. Between 2 and 4 years
of age, most children learn bladder and bowel control.

MENTAL DEVELOPMENT
 Mental development advances rapidly during early child- hood. Verbal growth progresses from the use
of several words at age 1 to a vocabulary of 1,500-
2,500 words at age 6. Two-year-olds have short
attention spans but are interested in many different
activities (Figure 8-5). They can remember details
and begin to understand con- cepts. Four-year-olds ask
frequent questions and usually recognize letters
and some words. They begin to make decisions
based on logic rather than on trial and error.

FIGURE 8-4 By 4 months of age, infants recognize

their caregivers and stare intently at others.
Bendao/www.Shutterstock.com
FIGURE 8-5 One to two-year-olds are interested
in many different activities, but they have short attention
spans.
© Aml
Parikh/www.Shutterstock.com
234
CHAPTER 8

By age 6, children are very verbal and want to learn

how to read and write. Memory has developed to the
point where the child can make decisions based on both
past and present experiences.

EMOTIONAL DEVELOPMENT

Emotional development also advances

rapidly. At ages 1-2, children begin to
develop self-awareness and to rec-
ognize the effect they have on other
people and things. Limits are usually
established for safety, leading the 1- or 2-
year-old to either accept or defy such
limits. By age 2, most children begin to
gain self-confidence and are en-
thusiastic about learning new things
(Figure 8-6). How- ever, children can feel
impatient and frustrated as they try to do
things beyond their abilities. Anger, often
in the form of "temper tantrums," occurs
when they cannot perform as desired.
Children at this age also like routine and
become stubborn, angry, or frustrated
when changes occur. From ages 4-6,
children begin to gain more con- trol
over their emotions. They understand the
concept of right and wrong, and
because they have achieved more
independence, they are not frustrated as much by their lack of ability. By age 6,
most children also show less anxiety
when faced with new experiences,
because they have learned they can deal
with new situations.

SOCIAL DEVELOPMENT

Social development expands from a self-

centered (ego- centric) 1-year-old to a sociable
6-year-old. In the early years, children are usually
strongly attached to their parents (or to the
individuals who provide their care), and they
fear any separation. They begin to enjoy the
company of others, but are still very possessive.
Playing alongside other children is more
common than playing with other children
(Figure 8-7). Gradually, children learn to put "self"
aside and begin to take more of an interest in
others. They learn to trust other people and
make more of an effort to please others by
 becoming more agreeable and social. Friends of
their own age are usually important to 6-year-olds.

NEEDS AND CARE

The needs of early childhood still include food, rest,

shelter, protection, love, and security. In addition,
chil- dren need routine, order, and consistency in their daily
lives. They must be taught to be responsible and must
learn how to conform to rules. This can be
accomplished by making reasonable demands based
on the child's abil- ity to comply.
While caring for toddlers, a health care provider must be sensitive to the child's fears and anxiety when
dealing with strangers. Enlisting the help of parents or
guardians, using a calm but firm approach,
establishing rapport with the child, using play to alleviate
fear, providing simple explanations to gain cooperation,
allowing the child to participate in care by providing one
or two choices, and

FIGURE 8-6 By age two, most children begin

to gain some self-confidence and are enthusiastic about
learning new things.
© Stuart
Monk/www.Shutterstock.com
FIGURE 8-7 Playing alongside and with other children allows preschoolers to learn how to interact with others.
malka_Wariatka/www.Shutterstock
com
4

reassuring the child are all ways to make care easier.

After a painful procedure, it is essential to comfort the
child. At all times, it is important to maintain a safe
environment and prevent the transmission of infection.
While caring for preschoolers, many of the
same techniques can be used. Because the child is
older, en- couraging verbalization of fears, answering
questions, allowing the child to make choices such as
what color cast to use to splint a fractured bone, praising the
for cooperating, making health education fun,
child
and lis- tening to the child's requests and trying to
fulfill them are additional techniques that can be used.

Late Childhood
PHYSICAL DEVELOPMENT
The late childhood life stage, which covers ages 6-12, is
also called preadolescence. Physical development is
slow but steady. Weight gain averages 4-7 pounds (2.3-
3.2 kg) per year, and height usually increases
approximately 2-3 inches (5-7.5 cm) per year. Muscle
coordination is well developed, and children can engage
in physical ac- tivities that require complex motor-
sensory coordination. During this age, most of the
primary teeth are lost, and permanent teeth erupt. The
eyes are well developed, and visual acuity is at its best.
During ages 10-12, secondary sexual characteristics begin
to develop in some children.

MENTAL DEVELOPMENT
Mental development increases rapidly because much of
the child's life centers around school. Speech skills de- velop
more completely, and reading and writing skills are learned.
Children learn to use information to solve problems, and the
memory becomes more complex. They begin to
understand more abstract concepts such as loy- alty,
honesty, values, and morals. Children use more active
thinking and become more adept at making judgments.

EMOTIONAL DEVELOPMENT
HUMAN GROWTH AND DEVELOPMENT
235

E
PP
7021
LPED
 FIGURE 8-8 Role-playing allows a child to control fears and gain self-confidence. Lisa Eastman/www.Shulterstock.com

Emotional development continues to help the child

achieve a greater independence and a more distinct
personality. At age 6, children are often frightened and
uncertain as they begin school. Reassuring parents and
success in school help children gain self-confidence.
Role-playing also allows a child to control fears and gain
self-confidence (Figure 8-8). Gradually, fears are replaced
by the ability to cope. Emotions are slowly brought under
control and dealt with in a more effective manner. By
ages 10-12, sexual maturation and changes in body
functions can lead to periods of depression fol- lowed
by periods of joy. These emotional changes can cause
children to be restless, anxious, and difficult to understand.
SOCIAL DEVELOPMENT

Social changes are evident during these years. Seven- year-olds tend to like activities they can do by them- selves
and do not usually like group activities. However, they
want the approval of others, especially their par- ents
and friends. Children from ages 8-10 tend to be more
group oriented, and they typically form groups with
members of their own sex. They are more ready to
accept the opinions of others and learn to conform to rules
and standards of behavior followed by the group. Toward
the end of this period, children tend to make friends more
easily, and they begin to develop an in- creasing
awareness of the opposite sex. As children spend
 more time with others their own age, their de-
pendency on their parent(s) lessens, as does the time
they spend with their parents.

NEEDS AND CARE

Needs of children in this age group include the same

ba- sic needs of infancy and early childhood, together
with the need for reassurance, parental approval,
and peer acceptance.
Because this age group is prone to accidents and mi- nor infections, health care providers must stress safety and
healthy living principles. Information should be provided
about nutrition, personal hygiene, sleep pat- terns,
exercise, dental hygiene, preventing infection, and
puberty. It is also important to encourage
independence and to allow the child to make his or her own decisions
whenever possible. Health care providers must be sensi- tive to
the child's need for privacy, but should make ev- ery effort to
encourage the child to discuss his or her concerns by
using a nonjudgmental approach.
236
CHAPTER 8
1

Adolescence
PHYSICAL DEVELOPMENT
Adolescence, ages 12 to 18, is often a traumatic life
stage. Physical changes occur most dramatically in the
early period. A sudden "growth spurt" can cause rapid
increases in weight and height. A weight gain of up to
25 pounds (11 kg) and a height increase of several
inches can occur in a period of months. Muscle
coordination does not advance as quickly. This can lead
to awkward- ness or clumsiness in motor coordination. This
growth spurt usually occurs anywhere from ages 11 to 13
in girls and ages 13 to 15 in boys.
The most obvious physical changes in
adolescents relate to the development of the sexual
organs and sec- ondary sexual characteristics,
frequently called puberty. Secretion of sex hormones leads
to the onset of men- struation
in girls and the production
of sperm and se- men in boys. Secondary sexual
characteristics in females include growth of pubic
hair, development of breasts and wider hips, and
distribution of body fat leading to the female shape. The
male develops a deeper voice; attains more muscle mass
and broader shoulders; and grows pubic, facial, and body
hair.

MENTAL DEVELOPMENT

Since most of the foundations have already been estab-

lished, mental development primarily involves an
increase in knowledge and a sharpening of skills.
Adolescents learn to make decisions and to accept
responsibility for their actions. At times, this causes conflict
because they are treated as both children and adults, or are
told to "grow up" while being reminded that they are
"still children.”

EMOTIONAL DEVELOPMENT

Emotional development is often stormy and conflicted. As

adolescents try to establish their identities and inde-
pendence, they are often uncertain and feel inadequate and
insecure. They worry about their appearance, their
abilities, and their relationships with others. They fre-
quently respond more and more to peer group influ- ences.
At times, this leads to changes in attitude and behavior
and conflict with values previously established. Toward
the end of adolescence, self-identity has been es-
tablished. At this point, teenagers feel more comfortable with
who they are and turn attention toward what they may
become. They gain more control of their feelings and
become more mature emotionally.

SOCIAL DEVELOPMENT

Social development usually involves spending less

time with family and more time with peer groups. As
adoles- cents attempt to develop self-identity and
independence,
FIGURE 8-9 Adolescents use the peer group as a safety net as they try to establish their identities and
independence.
iStockphoto/Chris
Schmidt

they seek security in groups of people their own age

who have similar problems and conflicts (Figure 8-9). If
these peer relationships help develop self-
confidence through the approval of others,
adolescents become more secure and satisfied. Toward
the end of this life stage, adoles- cents develop a more
 mature attitude and begin to de- velop patterns of
behavior that they associate with adult behavior or status.

NEEDS AND CARE

ance,
In addition to basic needs, adolescents need reassur-
support, and understanding. Many problems that develop
during this life stage can be traced to the conflict and
feelings of inadequacy and insecurity that adolescents
experience. Examples include eating disor- ders, drug
and alcohol abuse, and suicide. Even though these
types of problems also occur in earlier and later
life stages, they are frequently associated with
adolescence.
Eating disorders often develop from an excessive concern with appearance. Two common eating disorders
are anorexia nervosa and bulimia. Anorexia nervosa, commonly
called anorexia, is a psychological disorder in which a
person drastically reduces food intake or re- fuses to eat
at all. This results in metabolic disturbances, excessive weight
loss, weakness, and if not treated, death. Bulimia is a
psychological disorder in which a person alternately
binges (eats excessively) and then fasts, or re- fuses to eat at
all. When a person induces vomiting or uses laxatives to
get rid of food that has been eaten, the condition is called
bulimarexia. All three conditions are more common in female
than male individuals. Psycho- logical or psychiatric
help is usually needed to treat these conditions.
Chemical abuse is the use of substances such as al- cohol or drugs and the development of a physical and/or
mental dependence on these chemicals. Chemical
abuse can occur in any life stage, but it
frequently begins in ad- olescence. Reasons for
using chemicals include anxiety or stress relief, peer
pressure, escape from emotional or psychological
problems, experimentation with feelings the chemicals
produce, desire for "instant gratification,”
hereditary traits, and cultural influences. Chemical
abuse can lead to physical and mental disorders and
dis- ease. Treatment is directed toward total rehabilitation that
allows the chemical abuser to return to a productive
and meaningful life.
Suicide, found in many life stages, is one of the leading
causes of death in adolescents. Suicide is always a
permanent solution to a temporary problem. Reasons
for suicide include depression, grief over a loss or love
affair, failure in school, inability to meet expectations,
influence of suicidal friends, or lack of self-esteem. The risk for
suicide increases with a family history of sui- cide; a
major loss or disappointment; previous suicide attempts;
and/or the recent suicide of friends, family, or role
models (heroes or idols). The impulsive nature of
adolescents also increases the possibility of suicide.
Most individuals who are thinking of suicide give
warn- ing signs such as verbal statements like "I'd
rather be dead" or "You'd be better off without me." Other warn-
ing signs include:

Sudden changes in appetite and sleep

habits
⚫ Withdrawal, depression, and
moodiness
•

HUMAN GROWTH AND DEVELOPMENT

Early
Adulthood
PHYSICAL DEVELOPMENT
23
7

Early adulthood, ages 19-40, is frequently the most productive life stage. Physical development is basically complete,
muscles are developed and strong, and motor coordination is at its peak. This is also the prime child- bearing time
and usually produces the healthiest babies (Figure 8-10). Both male and female sexual development is at its
peak.

MENTAL DEVELOPMENT

Mental development usually continues throughout this stage. Many young adults pursue additional education to
establish and progress in their chosen careers.
Frequently, formal education continues for many
years. The young adult often also deals with
independence, makes career choices, establishes a
lifestyle, selects a marital partner, starts a family, and
establishes values, all of which involve making many
decisions and forming many judgments.
 •

Excessive fatigue or
agitation
•

Neglect of personal
hygiene
• Alcohol or drug abuse
•

Losing interest in hobbies and other aspects of

life Preoccupation with death
Injuring one's
body
•

Giving away
possessions
•

Social withdrawal from family and friends

These individuals are calling out for attention and

help, and usually respond to efforts of
assistance. Their direct and indirect pleas should
never be ignored. Sup- port, understanding, and
psychological or psychiatric counseling are used to
prevent suicide.
Because of the many conflicts adolescents experi-
ence, health care providers must be nonjudgmental to
establish rapport while providing care. It is essential to
listen to the adolescent's concerns, be sensitive to their
nonverbal behavior, involve them in decision making,
and answer questions as honestly and completely as
pos- sible. It is also important to provide education
about hygiene, nutrition, developmental changes,
sexually transmitted diseases, and substance abuse.
FIGURE 8-10 Early adulthood is the prime childbearing time and usually produces the healthiest babies. Rohit
Seth/www.Shutterstock.com
T

238 CHAPTER 8

EMOTIONAL DEVELOPMENT
Emotional development usually involves preserving
the stability established during previous stages. Young
adults are subjected to many emotional stresses related
to career, marriage, family, and other similar situations.
If emotional structure is strong, most young adults can
cope with these worries. They find satisfaction in their
achievements, take responsibility for their actions, and
learn to accept criticism and to profit from
mistakes.

SOCIAL DEVELOPMENT
Social development frequently involves moving
away from the peer group. Instead, young adults
tend to as- sociate with others who have similar ambitions and in-
terests, regardless of age. The young adult often
becomes involved with a mate and forms a family.
Young adults do not necessarily accept traditional
sex roles and fre- quently adopt nontraditional roles.
For example, male individuals fill positions as nurses and
secretaries, and female individuals enter administrative or
construction positions. Such choices have caused and will
continue to cause changes in the traditional patterns of
society.

NEEDS AND CARE

Needs of early adulthood include the same basic needs

as other age groups. In addition, young adults need
indepen- dence, social acceptance, self-confidence, and
reassurance.
During care, information must be provided to
allow young adults to make wise decisions regarding their
health status and wellness goals. Even though this is
usu- ally the healthiest life stage, choices made at this
time. can affect both middle and old age. It is also
important to listen to what the person is saying and to
observe non- verbal behavior. Individuals in this age
group frequently experience stress due to their
responsibilities. Sensitive supportive care is essential.

Middle Adulthood
PHYSICAL DEVELOPMENT

Middle adulthood, ages 40-65, is frequently called

middle age. Physical changes begin to occur during
these years. The hair tends to gray and thin, the skin
begins. to wrinkle, muscle tone tends to decrease, hearing
loss starts, visual acuity declines, and weight gain
occurs. Women experience menopause, or the end
of menstrua- tion, along with decreased hormone
production that causes physical and emotional changes.
Men also experi- ence a slowing of hormone production.
This can lead to physical and psychological changes, a
period frequently referred to as the male climacteric.
However, except in cases of injury, disease, or surgery,
men never lose the ability to produce sperm or to
reproduce.
MENTAL DEVELOPMENT
Mental ability can continue to increase during middle age, a fact that has been proved by the many individu- als in
this life stage who seek formal education. Middle adulthood is
a period when individuals have acquired an
understanding of life and have learned to cope with
many different stresses. This allows them to be more confident in
making decisions and to excel at analyzing situations.

EMOTIONAL DEVELOPMENT
Emotionally, middle age can be a period of
contentment and satisfaction, or it can be a time of crisis.
The emo- tional foundation of previous life stages and
the situa- tions that occur during middle age determine
emotional status during this period. Job stability,
financial success, the end of child rearing, and good
health can all contrib- ute to emotional satisfaction
(Figure 8-11). Stress, cre- ated by loss of job, fear of
aging, loss of youth and vitality, illness, marital
problems, or problems with children or aging parents,
can contribute to emotional feelings of de- pression,
insecurity, anxiety, and even anger. Therefore, emotional
status varies in this age group and is largely
determined by events that occur during this period.

SOCIAL DEVELOPMENT

Social relationships also depend on many factors.

Family relationships often see a decline as children
begin lives of their own and parents die. Work
relationships frequently replace family. Relationships
between husband and wife can become stronger as
they have more time together and opportunities to enjoy
success. However, divorce rates are also high in this
age group, as couples who have remained together
"for the children's sake" now separate. Friendships
are usually with people who have the same interests
and lifestyles.
FIGURE 8-11 Job stability and enjoyment during middle adulthood contribute to emotional satisfaction. Nagy
Melinda/www.Shutterstock.com
HUMAN GROWTH AND DEVELOPMENT
239

NEEDS AND CARE

Needs of middle adulthood include the same basic needs as
other
age groups. In addition, these individuals need self-
satisfaction, a sense of accomplishment, and sup-
portive social relationships.
Health care providers must encourage middle-aged
adults to identify risk factors to their health status and
to make changes to promote wellness. Increasing
exercise, improving nutrition, avoiding obesity,
quitting smok- ing, eliminating or decreasing alcohol
intake, and other similar actions can improve health
status and increase longevity. At this life stage,
individuals begin to see the physical signs of aging.
With proper guidance, they can learn how to practice
better health principles that will help establish a
pattern for later years of life. Nonjudg- mental
supportive care is important while helping indi- viduals
to establish and meet health goals.

Late Adulthood
PHYSICAL DEVELOPMENT
Late adulthood, age 65 and older, has many different
terms associated with it. These include "elderly,"
"senior citizen," "golden ager," and "retired citizen."
Much atten- tion has been directed toward this life stage in
recent years because people are living longer, and the
number of people in this age group is increasing daily.
Physical development is on the decline. All body
sys- tems are usually affected. The skin becomes dry,
wrinkled, and thinner. Brown or yellow spots (frequently
called "age spots") appear. The hair becomes thin
and frequently loses its luster or shine. Bones become
brittle and porous, and are more likely to fracture or break.
Cartilage between the vertebrae thins and can lead to a
stooping posture. Mus- cles lose tone and strength, which
can lead to fatigue and poor coordination. A decline in the
vous system leads to hearing loss,
function of the ner-
decreased visual acuity, and decreased tolerance for
temperatures that are too hot or too cold. Memory loss
can occur, and reasoning ability can diminish. The heart is
less efficient, and circulation de- creases. The kidney and
bladder are less efficient. Breath- ing capacity decreases
and causes shortness of breath. However, it is important
to note that these changes usually occur slowly over a
long period. Many individuals, because of better health
and living conditions, do not show physi- cal changes of
aging until their seventies and even eighties.

MENTAL DEVELOPMENT
Mental abilities vary among individuals. Elderly people
who remain mentally active and are willing to learn
new things tend to show fewer signs of decreased mental
ability (Figure 8-12). Although some 90-year-olds re-
main alert and well oriented, other elderly individuals
FIGURE 8-12 Elderly individuals who are willing to learn new things show fewer signs of decreased mental
ability. O privilege/www Shutterstock.com

show decreased mental capacities at much earlier ages. Short-term memory is usually first to decline. Many el-
derly individuals can clearly remember events that oc-
curred 20 years ago, but do not remember yesterday's
events. Diseases such as Alzheimer's disease can lead to
irreversible loss of memory, deterioration of intellectual
functions, speech and gait disturbances, and disorienta-
tion. Arteriosclerosis, a thickening and hardening of
the walls of the arteries, can also decrease the blood
supply to the brain and cause a decrease in mental abilities. These
diseases are discussed in greater detail in Chapter 10:4.

EMOTIONAL DEVELOPMENT
Emotional stability also varies among individuals in this
age group. Some elderly people cope well with the
stresses presented by aging and remain happy and
able to enjoy life. Others become lonely, frustrated,
withdrawn, and de- pressed. Emotional adjustment is
necessary throughout this cycle. Retirement, death
of a spouse and friends, phys- ical disabilities,
financial problems, loss of independence, and knowledge
that life must end all can cause emotional distress. The
adjustments that the individual makes during this life
stage are similar to those made throughout life.

SOCIAL DEVELOPMENT
Social adjustment also occurs during late adulthood.
Re- tirement can lead to a loss of self-esteem, especially
if work is strongly associated with self-identity: "I am a
teacher," instead of "I am Sandra Jones." Less contact with
cowork- ers and a more limited circle of friends usually occur.
 Many elderly adults engage in other activities and continue
to make new social contacts (Figure 8-13). Others limit
their social relationships. Death of a spouse and friends,
and moving to a new environment can also cause
changes in social relationships. Development of new
social contacts is important at this time. Senior centers,
golden age groups,
240
CHAPTER 8

FIGURE 8-13 Social contacts and activities are

important during late adulthood. Monkey Business
Images/www.Shutterstock.com

churches, and many other organizations help provide

the elderly with the opportunity to find new social roles.

NEEDS AND CARE

Needs of this life stage are the same as those of all
other life stages. In addition to basic needs, the elderly
need a sense of belonging, self-esteem, financial
security, social acceptance, and love.
While caring for older adults, health care
providers must use a nonjudgmental, supportive
approach. Encour- age them to talk; allow them as much
independence as possible; recognize achievements they
have accomplished; provide required health care
information as illnesses oc- cur; help them adjust and
adapt to physical and mental changes; allow them to
express fears and regrets, but re- mind them of positive
accomplishments; and help them find support
systems and social networks. Providing a safe
environment and preventing infection are also essential.

STUDENT: Go to the workbook and complete the

assignment sheet for 8:1, Life Stages.
 8:2 Death and
Dying
Death is often referred to as "the final stage of
growth." It is experienced by everyone and cannot be
avoided. In our society, the young tend to ignore its
existence. It is usually the elderly, having lost spouses
and/or friends, who begin to think of their own deaths.
When a patient is told that he or she has a
terminal illness, a disease that cannot be cured and will result in
death, the patient may react in different ways. Some
pa- tients react with fear and anxiety. They fear pain,
aban- donment, and loneliness. They fear the unknown.
They become anxious about their loved ones and about un- finished
work or dreams. Anxiety diminishes in patients
who feel they have had full lives and who have strong
religious beliefs regarding life after death. Some
patients view death as a final peace. They know it
will bring an end to loneliness, pain, and suffering.

Stages of Dying and

Death
Dr. Elisabeth Kübler-Ross has done extensive research on the process of death and dying, and is known as a
leading expert on this topic. Because of her research,
most medi- cal personnel now believe patients should be
told of their approaching deaths. However, patients
should be left with "some hope" and the knowledge
that they will "not be left alone." It is important that
all staff members who provide care to the dying patient
know both the extent of informa- tion given to the patient
and how the patient reacted.
Dr. Kübler-Ross has identified five stages of grieving that dying patients and their families/friends may
expe- rience in preparation for death. The stages may
not oc- cur in order, and they may overlap or be
repeated several times. Some patients may not
progress through all of the stages before death
occurs. Other patients may be in sev- eral stages at
the same time. The five stages are denial, anger,
bargaining, depression, and acceptance.
Denial is the "No, not me!" stage, which usually occurs when a person is first told of a terminal illness. It
occurs when the person cannot accept the reality of
death or when the person feels loved ones cannot accept
the truth. The person may make statements such as
"The doctor does not know what he is talking about" or
 "The tests have to be wrong." Some patients seek second
medical opinions or request additional tests. Others
refuse to discuss their situations and avoid any
references to their illnesses. It is important for patients
to discuss these feelings. The health care worker should
listen to a patient and try to provide support without
confirming or denying. Statements such as "It must be
hard for you" or "You feel additional tests will
help?" will allow the patient to express feelings and
move on to the next stage.
Anger occurs when the patient is no longer able to deny death. Statements such as "Why me?" or "It's
your fault" are common. Patients may strike out at
anyone who comes in contact with them and become hostile and
bitter. They may blame themselves, their loved ones, or
health care personnel for their illnesses. It is important
for the health care worker to understand that this anger is not
a personal attack; the anger is caused by the situ- ation
the patient is experiencing. Providing understand- ing and
support, listening, and making every attempt to
respond to the patient's demands quickly and with
kind- ness is essential during this stage. This stage
continues until the anger is exhausted or the patient must
attend to other concerns.
HUMAN GROWTH AND DEVELOPMENT
241
 FIGURE 8-14 Depression can be a normal stage of
grieving in a dying patient. © Voronin76/www
Shutterstock.com

Bargaining occurs when patients accept death but

want more time to live. Frequently, this is a period when
patients turn to religion and spiritual beliefs. At this
point, the will to live is strong, and patients fight hard to
achieve goals set. They want to see their children
graduate or get married, they want time to arrange care
for their families, they want to hold new grandchildren,
or other similar desires. Patients make promises to God
in order to obtain more time. Health care workers must again be
supportive and be good listeners. Whenever possible,
they should help patients meet their goals.
Depression occurs when patients realize that
death will come soon and they will no longer be with
their families or be able to complete their goals.
They may ex- press these regrets, or they may
withdraw and become quiet (Figure 8-14). They
experience great sadness and, at times,
overwhelming despair. It is important for health
care workers to let patients know that it is "OK" to be
de- pressed. Providing quiet understanding, support,
and/or a simple touch, and allowing patients to cry or
express grief are important during this stage.
Acceptance is the final stage. Patients
understand and accept the fact that they are going to
die. Patients may complete unfinished business and try
to help those
FIGURE 8-15 The support and presence of others is important to the dying person. ©iStockphoto/Jodi Jacobson

around them deal with the oncoming death. Gradually,

patients separate themselves from the world and other
people. At the end, they are at peace and can die with
dignity. During this final stage, patients still need
emo- tional support and the presence of others, even
if it is just the touch of a hand (Figure 8-15).

Hospice
Care
Providing care to dying patients can be very difficult, but very rewarding. Providing supportive care when families
and patients require it most can be one of the greatest
satisfactions a health care worker can experience. To be able
to provide this care, however, health care workers must
 first understand their own personal feelings about death
and come to terms with these feelings. Feelings of fear,
frustration, and uncertainty about death can cause
workers to avoid dying patients or provide superficial,
mechanical care. With experience, health care workers can
find ways to deal with their feelings and learn to pro-
vide the supportive care needed by the dying.
Hospice care can play an important role in meeting the needs of the dying patient. Hospice care offers pal- liative
care, or care that provides support and comfort. It can
be offered in hospitals, medical centers, and special
facilities, but most frequently it is offered in the patient's
home. Hospice care is not limited to a specific time
period in a patient's life. Usually it is not started until
a physician declares that the patient has 6 months
or less to live, but it can be started sooner. Most
often patients and their fami- lies are reluctant to
begin hospice care because they feel that this action
recognizes the end of life. They seem to feel that if they
do not use hospice care until later, death will not be as
near as it actually is. The philosophy behind hospice
care is to allow the patient to die with dignity and
comfort. Using palliative measures of care and the phi-
losophy of death with dignity provides patients and
fami- lies with many comforts and provides an
opportunity to
242
CHAPTER 8

find closure. Some of the comforts provided by

hospice may include providing hospital equipment
such as beds, wheelchairs, and bedside commodes;
offering psycho- logical, spiritual, social, and
financial counseling; and providing free or less
expensive pain medication. Pain is controlled so that
the patient can remain active as long as possible. In
medical facilities, personal care of the patient is
provided by the staff; in the home situation, this care is
provided by home health aides and other health care
professionals. Specially trained volunteers are an
impor- tant part of many hospice programs. They
make regular visits to the patient and family, stay with
the patient while the family leaves the home for brief
periods of time, and help provide the support and
understanding that the pa- tient and family need. When
the time for death arrives, the patient is allowed to die
with dignity and in peace. After the death of the patient,
hospice personnel often maintain contact with the
family during the initial period of mourning.

Right to
Die

IIII
The right to die is another issue that health
care workers must understand. Because health care
workers are ethically concerned with
promoting
Legal life, allowing patients to
die can cause conflict.
However, a large number of surveys have shown that
most people feel that an individual who has a terminal
illness, with no hope of being cured, should be allowed to
refuse measures that would prolong life. A federal law
called the Patient Self-Determination Act mandates
that every individual has the right to make decisions
regard- ing medical care, including the right to refuse
treatment and the right to die. Adults who have terminal
illnesses may instruct their doctors, in writing, to
withhold treat- ments that might prolong life. The law
involves the use of advance directives, discussed in
Chapter 5:4. Under this law, specific actions to end life
cannot be taken. However, the use of respirators,
pacemakers, and other medical devices can be
withheld, and the person can be allowed to die with
dignity.
Caring Connections, a program of the National
Hospice and Palliative Care Organization, created a
na- tional LIVE campaign to encourage individuals to
make decisions about end-of-life care and services through
the LIVE promise. This promise encourages
individuals to:
Learn about end-of-life services and care

Implement plans or advance directives to ensure

wishes are honored

• Voice decisions

Engage others in conversations about end-of-life care

options
Health care workers must be aware that a dying per- son has rights that must be honored. A Dying
Person's Bill of Rights was created at a workshop
sponsored by the Southwestern Michigan Inservice
Education Council. This bill of rights states:
 •

⚫ I have the right to be treated as a living human

being
until I die.

I have the right to maintain a sense of hopefulness, however changing its focus may be.
⚫ I have the right to be cared for by those who can
maintain a sense of hopefulness, however
challenging this might be.
•

I have the right to express my feelings and emotions about my approaching death in my own way.
I have the right to participate in decisions
concerning my care.
⚫ I have the right to expect continuing medical and
nursing attention even though "cure" goals must
be changed to "comfort" goals.

I have the right not to die alone.

I have the right to be free from

pain.
I have the right to have my questions answered honestly.

I have the right not to be deceived.

I have the right to have help from and for my family in accepting my death.
 I have the right to die in peace and with
dignity.
I have the right to maintain my individuality and not be judged for my decisions, which may be contrary to the
beliefs of others.

I have the right to expect that the sanctity of the

hu- man body will be respected after death.
I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to under- stand
my needs and will be able to gain some satisfac-
tion in helping me face my death.
I have the right to discuss and enlarge my religious
and/ or spiritual experiences, whatever these may
mean to others.

Health care workers deal with death and with dying patients because death is a part of life. By understanding
the process of death and by thinking about the needs
of dying patients, the health care worker will be
able to pro- vide the special care needed by these
individuals.

STUDENT: Go to the workbook and complete

the assignment sheet for 8:2, Death and Dying.
1

8:3 Human
Needs
Needs are frequently defined as "a lack of
something that is required or desired." From the
moment of birth to the moment of death, every human
being has needs. Needs motivate the individual to behave or act
so that these needs will be met, if at all possible.
Certain needs have priority over other needs. For
example, at times a need for food may take priority
over a need for social approval, or the approval of
others. If individuals have been without food for a period
of time, they will direct most of their actions toward
obtaining food. Even though they want social approval
and the re- spect of others, they may steal for food,
knowing that stealing may cause a loss of social
approval or respect.
Maslow's Hierarchy of Needs
Abraham Maslow, a noted psychologist, developed a
hierar- chy of needs (Figure 8-16). According to Maslow,
the lower needs should be met before an individual can strive to
meet higher needs. Only when satisfaction has been
obtained at one level is an individual motivated toward
meeting needs at a higher level. The levels of needs include
physiological needs, safety, affection, esteem, and self-
actualization.

PHYSIOLOGICAL NEEDS
Physiological needs are often called "physical," "bio-
logical," or "basic" needs. These needs are required by
every human being to sustain life. They include food,
HUMAN GROWTH AND DEVELOPMENT
24
3

water, oxygen, elimination of waste materials, sleep, and protection from extreme temperatures. These needs
must be met for life to continue. If any of these needs
goes unmet, death will occur. Even among these
needs, a priority exists. For example, because lack of
oxygen will cause death in a matter of minutes, the need for
oxygen has priority over the need for food. A patient
with severe lung disease who is gasping for every
breath will not be concerned with food intake. This
cern will be to obtain enough oxygen
individual's main con-
to live through the next minute.
Other physiological needs include sensory and mo- tor needs. If these needs are not met, individuals may not die,
but their body functions will be affected. Sen- sory needs
include hearing, seeing, feeling, smelling, tasting, and
mental stimulation. When these needs are met, they allow
the individual to respond to the environ- ment. If these
needs are not met, the person may lose contact with the
is motor needs,
environment or with reality. An ex- ample
which include the ability to move and respond to
the individual's environment. If muscles are not
stimulated, they will atrophy (waste away), and function
will be lost.
Many of the physiological needs are automati- cally controlled by the body. The process of breathing is
usually not part of the conscious thought process of the
individual until something occurs to interfere with breathing.
Another example is the functioning of the urinary
bladder. The bladder fills automatically, and the
individual only becomes aware of the bladder when it is
full. If the individual does not respond and go to the
 Self-Actualization
Obtain full potential,
Confident, Self-
secure

Esteem Self-
respect,
Has approval of
others

Love and affection

Feel sense of
belonging,
Can give and receive friendship
and love

Safety and security Free

from fear and anxiety,
Feel secure in the environment

Physiological
needs
Food, Water, Oxygen, Elimination of
waste Protection from temperature
extremes, Sleep

FIGURE 8-16 Maslow's Hierarchy of Needs: the lower needs should be met before the individual can try to
meet higher needs. Copyright Cengage Learning All Rights Reserved, Adaption based on Maslow's Hierarchy of Needs
244
CHAPTER 8

restroom to empty the bladder, eventually control

will be lost and the bladder will empty itself.
Health care workers must be aware of how an illness
interferes with meeting physiological needs. A patient
scheduled for surgery or laboratory tests may not be al-
lowed to eat or drink before the procedure. Anxiety about
an illness may interfere with a patient's sleep or
elimina- tion patterns. Medications may affect a
patient's appetite. Elderly individuals are even more
likely to have difficulty meeting physiological needs. A
loss of vision or hearing due to aging may make it
difficult for an elderly person to communicate with others. A
decreased sense of smell and taste can affect appetite.
Deterioration of muscles and joints can lead to poor
coordination and difficulty in walking. Any of these
factors can cause a change in a person's behavior. If
health care workers are aware that physiological needs
are not being met, they can provide understanding
and support to the patient and make ev- ery effort to
help the patient satisfy the needs.

SAFETY
 Safety becomes important when physiological
needs have been met. Safety needs include the need to
be free from anxiety and fear, and the need to feel
secure in the environment. The need for order and routine is
another example of an individual's effort to remain safe and
se- cure. Individuals often prefer the familiar over the un-
known. New environments, a change in routine, marital
problems, job loss, injury, disease, and other similar
events can threaten an individual's safety.
Illness is a major threat to an individual's
security and well-being. Health care workers are familiar with
laboratory tests, surgeries, medications, and
therapeutic treatments. Patients are usually frightened
when they are exposed to them and their sense of
security is threat- ened. If health care workers explain
the reason for the tests or treatments and the
expected outcomes to the pa- tient, this can frequently
alleviate the patient's anxieties. Patients admitted to a
health care facility or long-term care facility must
adapt to a strange and new environ- ment. They
frequently experience anxiety or depression.
Patients may also experience depression over the loss of
health or loss of a body function. Health care workers
must be aware of the threats to safety and security that
patients are experiencing, and must make every effort
to explain procedures, provide support and
understanding, and help patients adapt to the
situation.

LOVE AND AFFECTION

feeling
The need for love and affection, a warm and tender
for another person, occupies the third level of
Maslow's Hierarchy of Needs. When an individual feels safe
and secure, and after all physiological needs have
been met, the individual next strives for social
ассер- tance, friendship, and to be loved. The need to
belong, to relate to others, and to win approval of others
moti- vates an individual's actions at this point. The
individ- ual may now attend a social function that was
avoided when safety was more of a priority. Individuals
who feel safe and secure are more willing to accept
and adapt to change and are more willing to face
unknown situations. The need for love and affection is satisfied
are made, social contacts are established,
when friends
acceptance by others is received, and the individual is
able to both give and receive affection and love (Figure 8-
17).
 Maslow states that sexuality is both a part of the need for love and affection, as well as a physiological
need. Sexuality in this context is defined by people's
feelings concerning their masculine/feminine natures,
their abilities to give and receive love and affection, and
finally, their roles in reproduction of the species. It is
important to note that in all three of these areas, sexual- ity
involves a person's feelings and attitudes, not just the
person's sexual relationships.
It is equally important to note that a person's sexual- ity extends throughout the life cycle. At conception, a
person's sexual organs are determined. Following birth,
a person is given a name, at least generally associated
with the person's sex. Studies have shown that children
receive treatment according to gender from early child-
hood and frequently are rewarded for behavior that is
deemed "gender appropriate." With the onset of
puberty, adolescents become more aware of their
emerging sexu- ality and of the standards that society
places on them. During both childhood and
adolescence, much of what

FIGURE 8-17 Individuals of all ages need love and affection. Courtesy of Sandy Clark
is learned about sexuality comes from observing adult
role models. As the adolescent grows into young adult-
hood, society encourages a reexamination of sexuality
and the role it plays in helping to fulfill the need for love
and affection. In adulthood, sexuality develops new
meanings according to the roles that the adult takes
on. Sexuality needs do not cease in late adulthood.
Long- term care facilities are recognizing this fact by
allowing married couples to share a room, instead of
separating people according to sex. Even after the
death of a spouse, an individual may develop new
relationships. Determin- ing what role sexuality will
play in a person's life is a dy- namic process that
allows people to meet their need for love and affection
throughout their life.
Sexuality, in addition to being related to the satisfac-
tion of needs, is also directly related to an individual's
moral values. Issues such as the appropriateness of sex
before marriage, the use of birth control, how to deal with
pregnancy, and how to deal with sexually trans- mitted
diseases all require individuals to evaluate their moral beliefs.
These beliefs then serve as guidelines to help people reach
decisions on their behaviors.
Some individuals use sexual relationships as sub-
stitutes for love and affection. Individuals who seek to meet their
needs only in this fashion cannot successfully complete
Maslow's third level.

ESTEEM

Esteem includes
Maslow's fourth level includes the need for esteem.
feeling important and worthwhile. When others show
respect, approval, and apprecia- tion, an individual
begins to feel esteem and gains self- respect. The
self-concept, or beliefs, values, and feelings
people have about themselves, becomes positive. Indi-
viduals will engage in activities that bring achievement,
success, and recognition in an effort to maintain their
need for esteem. Failure in an activity can cause a loss
of confidence and lack of esteem. When esteem needs are met,
individuals gain confidence in themselves and begin to
direct their actions toward becoming what they want to
be.
Illness can have a major effect on esteem. When
self- reliant individuals, competent at making decisions,
find themselves in a health care facility and dependent
on others for basic care such as bathing, eating, and
elimi- nation, they can experience a severe loss of
esteem. They may also worry
about a lack of income, possible job
loss, the well-being of their family, and/or the possibility
of permanent disability or death. Patients may become
an- gry and frustrated or quiet and withdrawn. Health
care workers must recognize this loss of esteem and
make ev- ery attempt to listen to the patient, encourage
as much independence as possible, provide supportive
care, and allow the person to express anger or fear.
 HUMAN GROWTH AND DEVELOPMENT
245

SELF-ACTUALIZATION
Self-actualization, frequently called self-realization,
is the final need in Maslow's hierarchy. All other needs
must be met, at least in part, before self-actualization can
occur. Self-actualization means that people have obtained
their full potentials, or that they are what they want to
be. People at this level are confident and willing to
express their beliefs and stick to them. They feel so
strongly about themselves that they are willing to reach
out to others to provide assistance and support.

Meeting
Needs
When needs are felt, individuals are motivated (stimu- lated)
to act. If the action is successful and the need is met,
satisfaction, or a feeling of pleasure or fulfillment,
occurs. If the need is not met, tension, or frustration, an
uncomfortable inner sensation or feeling, occurs. Sev- eral needs
must decide which
can be felt at the same time, so individuals
needs are stronger. For example, if individuals need both
food and sleep, they must decide which need is most
important, because an individual cannot eat and sleep
at the same time.
Individuals feel needs at different levels of intensity. The more intense a need, the greater the desire to meet or
reduce the need. Also, when an individual first expe-
riences a need, the individual may deal with it by trying
different actions in a trial-and-error manner, a type of
behavior frequently seen in very young children. As
they grow older, children learn more effective means of
meet- ing the need and are able to satisfy the need
easily.

Methods of
Satisfying
Human Needs
Needs can be satisfied by direct or indirect methods. Direct
methods work at meeting the need and obtaining
satisfac- tion. Indirect methods work at reducing the
need or reliev- ing the tension and frustration created
by the unmet need.
 DIRECT METHODS
Direct methods include:

Hard work

Realistic
goals
Situation evaluation

Cooperation with
others
All these methods are directed toward meeting the need.
Students who constantly fail tests but who want to pass a
course have a need for success. They can work harder
by listening more in class, asking questions on points they
do not understand, and studying longer for the tests. They
can set realistic goals that will allow them to
246
CHAPTER 8

find success. By working on one aspect of the course

at a time, by concentrating on new material for the next
test, by planning to study a little each night rather than
study- ing only the night before a test, and by
working on other things that will enable them to pass,
they can establish goals they can achieve. They can
evaluate the situation to determine why they are failing
and to try to find other ways to pass the course.
They may determine that they are always tired in
class and that by getting more sleep, they will be able
to learn the material. They can cooper- ate with
others. By asking the teacher to provide extra assistance,
by having parents or friends question them on the
material, by asking a counselor to help them learn
better study habits, or by having a tutor provide extra
help, they may learn the material, pass the tests, and
achieve satisfaction by meeting their need.

INDIRECT METHODS

Indirect methods of dealing with needs usually reduce

the need and help relieve the tension created by the
unmet need. The need is still present, but its intensity
decreases. Defense mechanisms, unconscious acts
that help a per- son deal with an unpleasant situation or
socially unac- ceptable behavior, are the main indirect
methods used. Everyone uses defense mechanisms to
some degree. Defense mechanisms provide methods for
maintaining self-esteem and relieving discomfort. Some use
of de- fense mechanisms is helpful because it allows
individuals to cope with certain situations. However, defense
mecha- nisms can be unhealthy if they are used all the
time and individuals substitute them for more effective
ways of dealing with situations. Being aware of the use of
defense mechanisms and the reason for using them is a
healthy use. This allows the individual to relieve tension while
modifying habits, learning to accept reality, and striving to
find more efficient ways to meet needs.
Examples of defense mechanisms
include:
• Rationalization: This involves using a reasonable
ex- cuse or acceptable explanation for behavior to
avoid the real reason or true motivation. For example,
a patient who fears having laboratory tests performed
may tell the health worker, "I can't take time off from my job,"
rather than admit fear.

Projection: This involves placing the blame for

one's own actions or inadequacies on someone else
or on circumstances rather than accepting
responsibility for the actions. Examples include,
"The teacher failed me because she doesn't like me," rather
than "I failed because I didn't do the work"; and "I'm late
becausethe alarm clock didn't go off," rather than
"I forgot to set the alarm clock, and I overslept."
When people use projection to blame others, they
avoid having to admit that they have made mistakes.
•
 •

Displacement: This involves transferring feelings about one person to someone else. Displacement usually occurs
because individuals cannot direct the feelings
toward the person who is responsible. Many people
fear directing hostile or negative feelings to- ward
their bosses or supervisors because they fear job loss.
They then direct this anger toward cowork- ers and/or
family members. The classic example is the man who
is mad at his boss. When the man gets home, he yells
at his wife or children. In such a case, a constructive
talk with the boss may solve the prob- lem. If not,
or if this is not possible, physical activity can help
work off hostile or negative feelings.
Compensation: This involves the substitution
of one goal for another goal to achieve success. If a
substi- tute goal meets needs, this can be a healthy
defense mechanism. For example, Joan wanted to be a
doc- tor, but she did not have enough money for a
medical education. So she changed her educational
plans and became a physician's assistant.
Compensation was an efficient defense mechanism
because she enjoyed her work and found satisfaction.

Daydreaming: This is a dreamlike thought process that occurs when a person is awake. Daydreaming
provides a means of escape when a person is not
sat- isfied with reality. If it allows a person to
establish goals for the future and leads to a course
of action to accomplish those goals, it is a good
defense mecha- nism. However, if daydreaming is
a substitute for re- ality, and the dreams become
more satisfying than actual life experiences, it can
contribute to a poor adjustment to life. For example,
if a person dreams about becoming a dental hygienist
and takes courses and works toward this goal,
daydreaming is effective. If the person dreams
about the goal but is satisfied by the thoughts and
takes no action, the person will not achieve
the goal and is simply escaping from reality.
Repression: This involves the transfer of unaccept-
able or painful ideas, feelings, and thoughts into the
unconscious mind. An individual is not aware that this is
occurring. When feelings or emotions become too
painful or frightening for the mind to deal with,
repression allows the individual to continue func-
tioning and to "forget" the fear or feeling. Repressed
feelings do not vanish, however. They can resurface
in dreams or affect behavior. For example, a person
is terrified of heights but does not know why. It
 is pos- sible that a frightening experience regarding
heights happened in early childhood and that the
experience was repressed.

Suppression: This is similar to repression, but the

individual is aware of the unacceptable feelings or
thoughts and refuses to deal with them. The
individual

may substitute work, a hobby, or a project to avoid the

situation. For example, a woman ignores a lump in
her breast and refuses to go to a doctor. She avoids
thinking about the lump by working overtime and
joining a health club to exercise during her spare
time. This type of behavior creates excessive
stress, and eventually the individual will be forced to
deal with the situation.

Regression: This involves retreating to a previous

developmental level that provided more safety and
security than the current level an individual is ex-
periencing. For example, an 8-year-old child might
scream at being separated from parents or start suck-
ing his or her thumb as a result of a hospitalization
or serious illness. The child is regressing to the
comfort of parents or thumb sucking to avoid the
conflicts and stress of the illness or
hospitalization.
Denial: This involves disbelief of an event or idea that is too
frightening or shocking for a person to cope with. Often,
an individual is not aware that denial is occurring. Denial
frequently occurs when a terminal illness is
diagnosed. The individual will say that the doctor is
wrong and will seek another opinion. When the
individual is ready to deal with the event or idea,
denial becomes acceptance.

TODAY'S RESEARCH
TOMORROW'S
HEALTH CARE
HUMAN GROWTH AND DEVELOPMENT
247

withdrawal
• Withdrawal: There are two main
ways can occur: individuals can either cease to communi- cate
or remove themselves
physically from a situation (Figure 8-18). Withdrawal
is sometimes a satisfactory means of avoiding
conflict or an unhappy situation. For example, if you
are forced to work with an indi- vidual you dislike and
who is constantly criticizing your work, you can
withdraw by avoiding any and all communication
with this individual, quitting your

FIGURE 8-18 Refusing to communicate is a sign of

withdrawal.
© iStockphoto/Brad
Killer

A Microchip to Cure
Diabetic Retinopathy?
Diabetes mellitus is a chronic disease caused by a
decreased secretion of insulin, a hormone that is
needed by body cells to absorb glucose (sugar) from
the blood. According to the National Institutes for
Health (NIH) approximately 25.8 million people
have diabetes, 18.8 million diagnosed and 7
million undiagnosed. A common complication of
diabetes is diabetic retinopathy, a disorder of the
retina, or nerve-sensitive layer of the eye that
provides vision. Diabetic retinopathy affects
approximately 28 percent of people with diabetes
 and is the leading cause of blindness.
Treatment for diabetic retinopathy has its
limitations. Laser therapy is used, but it can cause
diminished peripheral (side) and night vision and
cause laser burns that damage the eyes. A cancer
drug, docetaxel, is effective but the high dosages
required to produce the desired effect cause toxic
damage to other tissues in the body. Now a team
of research- ers in Canada has created a micron-sized
electromechanical system, commonly called a
"MEMS," that can be implanted behind the eyes to
release docetaxel on command using an external
magnet. The team made the device from a
reservoir loaded with docetaxel, sealed in place with an
elastic mag- netic membrane. By applying a
magnetic field, the team was
1

able to trigger the release of a specific amount of

docetaxel into the back of the eye, similar to a
squirt bottle. The team also found that the MEMS
device lasted for more than two months without
significant leakage of the medication. Dr. Mu
Chiao, the head of research at the University of
British Columbia (UBC) MEMS and
nanotechnology department, does recognize two
problems with current technologies. One problem
is that they are either battery operated or too large
for use in the eye. The second problem is that they
rely on diffusion, which means the drug-release
rates cannot be stopped and therefore it is difficult
to deliver the dosage the patient requires. Dr.
Chiao also admits there are still many challenges
that must be overcome before the mechanical
device can be designed to treat specific diseases.
Many other researchers are trying to develop MEMS to treat specific diseases. Some researchers are
evaluating MEMS that secrete blood-clotting
factors for individuals with hemophilia. Others are
trying to develop MEMS that will carry dopamine to
treat Parkinson's disease. Think of a future in which
tiny capsules floating or implanted in the body will cure
chronic diseases and allow individuals to live long
and healthy lives.
248
CHAPTER 8

job, or asking for a transfer to another area. At times,

however interpersonal conflict cannot be avoided. In
these cases, an open and honest communication
with the individual may lead to improved
 understanding in the relationship.

It is important for health care workers to be

aware of both their own and patients' needs. By
recognizing

CHAPTER 8
SUMMARY
Human growth and development is a process that
begins at birth and does not end until death. Each
individual passes through certain stages of growth
and development, frequently called life stages.
Each stage has its own characteristics and has
specific developmental tasks that an individual must
master. Each stage also establishes the foundation
for the next stage.
Death is often called "the final stage of
growth." Dr. Elisabeth Kübler-Ross has identified
five stages that dying patients and their families
may experience before death. These stages are
denial, anger, bargaining, depression, and accep-
tance. The health care worker must be aware of these
stages to provide supportive care to the dying
patient. In addition, the health care worker must
understand the concepts represented by hospice
care and the right to die.
Each life stage creates needs that must be
met by the individual. Abraham Maslow, a noted
psychologist, developed
needs and understanding the actions individuals
take to meet needs, more efficient and higher quality
care can be provided. Health care workers will be
better able to un- derstand their own behavior and the
behavior of others.

STUDENT: Go to the workbook and complete the assignment sheet for 8:3, Human Needs.

a hierarchy of needs that is frequently used to classify and de- fine the needs experienced by human
beings. The needs are classified into five levels,
and according to Maslow, the lower needs must be met
before an individual can strive to meet the higher needs.
The needs, beginning at the lowest level and
 progressing to the highest, are physiological,
or physical, needs; safety and security; love and
affection; esteem; and self-actualization.
Needs are met or satisfied by direct and indirect methods. Direct methods meet and eliminate a need. Indirect
methods.usually the use of defense mechanisms,
reduce the need and help relieve the tension created
by the unmet need.
Mastering these concepts will allow health care workers to develop good interpersonal relationships
and provide more effective health care.

INTERNET
SEARCHES
Use the suggested search engines in Chapter
12:4 in this text to search the Internet for additional
information on the following topics:

1. Erikson's stages of psychosocial development:

Search for more details and examples of the stages of
development.

2. Piaget's stages of cognitive development:

Search for
additional information on Piaget and on other
theories of development.

3. Stages of human growth and

development: Search words such as infancy,
childhood, adolescence, puberty, and adulthood to
obtain information on each stage.

4. Eating disorders: Search for statistics;

signs and
symptoms; and treatment of anorexia nervosa,
bulimia, and bulimarexia.
5. Chemical or drug abuse: Search for
statistics,
signs/symptoms, and treatment of chemical
and drug abuse. (Hint: use words such as
alcoholism and cocaine.)

6. Suicide: Search for statistics, signs/symptoms,

and ways
to prevent
suicide.

7. Death and dying: Search for information on Dr.

Kübler-
Ross, hospice care, palliative treatment, advance directives, and the right to die.

8. Maslow's Hierarchy of Needs: Search for

additional
information on each of the five levels of
needs.

9. Defense mechanisms: Search for specific

information
on rationalization, projection, displacement,
compensation, daydreaming, repression,
suppression, regression, denial, withdrawal, and
other defense mechanisms.
1
HUMAN GROWTH AND
DEVELOPMENT 249

REVIEW
QUESTIONS
1. Differentiate between growth and
development.
2. List the seven (7) life stages and at least two (2)
physical, mental, emotional, and social
developments that occur in each stage.

3. Identify similarities and differences in how a

health
care provider would care for a 4-year-old child
versus a 15-year-old adolescent.

4. Create an example for what a patient and/or

family
member might say or do during each of the five (5) stages
of death and dying.
5. Explain what is meant by the "right to die." Do
you believe
in this right? Why or why
not?

6. Identify each level of Maslow's Hierarchy of Needs

and give
examples of specific needs at each
level.

7. Create a specific example for each of the following

defense
mechanisms: rationalization, projection, displacement, compensation, daydreaming, repression, suppression,
regression, denial, and withdrawal.