Implementing  nursing care to clients across the life span  is easier when planning is based on a theoretical framework. A developmental approach encourages care directed at the client's current level of functioning.
The study of human growth and development is a subdivision of psychology. The following notes are indicated only to be a review of  growth and development theories. For more in-depth references refer to your psychology book a basic nursing skills book or Kearney(Nunnery) pages 59-63.
 
 

DEVELOPMENTAL THEORISTS: NEWBORN TO ADOLESCENCE
 

Freud's Stages of Development

Sigmund Freud ( 1856-1939)

The theories of Freud are controversial today. He believed that the personality was fully developed by age twelve. He said that personality must develop in a certain way and at strictly defined ages and that failure to progress in this manner would lead to dysfunction. Remember too, that in that time the life span was much shorter and age twelve seemed much older than it does by today's standards.
 

Stage of Development	Approximate Ages	Tasks/ Characteristics	Examples of Unsuccessful Task Completion
Oral	Birth - 18 months	Use mouth and tongue to deal with anxiety	Smoking, alcoholism, obesity, nailbiting, drug addiction, difficulty trusting
Anal	18 months - 3 years	Muscle control in bladder, rectum and anus provides sensual pleasure	Constipation, perfectionism, obsessive-compulsive disorder
Phallic	3-6 years	*Learning sexual identity and awareness of genital areas as a source of pleasure. * Penis Envy-Daughter wants father for herself; discovers that boys are different from her. *Oedipus Complex -Son wants mother to himself and the father is a rival.	Homosexuality, transsexuality, difficulty accepting authority
Latency	6-12 years	Quiet stage in sexual development, learns socialization	Inability to conceptualize, lack of motivation
Genital	12 years to adulthood	Sexual maturity and satisfaction	Frigidity, impotence, premature ejaculation, unsatisfactory relationships

 

ERIK ERIKSON
(1902-1994)

Erik Erikson was a follower of freud.  Erikson understood that people were individuals and that everyone is different. He took Freud's main concepts and expanded them to include an emotional component. His tasks are always listed as contradictions of each other. This is one way Erikson indicated his thoughts about emotional fluctuations.
 

STAGE	APPROXIMATE  AGES	DEVELOPMENTAL TASKS	EXAMPLES	EXAMPLES OF UNSUCCESSFUL TASK COMPLETION
Sensory	Birth- 18 months	Trust vs Mistrust	Nurturing people build trust in the newborn	Suspicious, trouble with personal relationships
Muscular	1-3 years	Autonomy vs Shame and Doubt	Toddler learns environment can be manipulated	Low self-esteem, dependency on substances or other people
Locomotor	3-6 years	Initiative vs Guilt	Child learns assertiveness can manipulate environment	Passive personality, strong feelings of guilt
Latency	6-12 years	Industry vs Inferiority	Creativity or shyness develops	Unmotivated, unreliable
Adolescence	12-20 years	Identity vs Role confusion	Individual integrates life experiences of becomes confused	Rebellion, substance abuse
Young Adult	18-25 years	Intimacy vs Isolation	Main concern is developing intimate relationships with another	Emotional immaturity, may deny need for personal relationships
Adulthood	21-45 years	Generativity vs Stagnation	Focus is on establishing a family and guiding the next generation	Inability to show concern for anyone but self
Maturity	45 years-death	Integrity vs Despair	Individual accepts owl life as fulfilling	Has difficulty dealing with issues of aging and death

 

JEAN PIAGET
(1896-1980)

A Swiss psychologist with a completely different outlook from Freud or Erikson, Piaget's theory is called cognitive development. Cognitive means the ability to reason, make judgments and learn. Piaget believed that development was not as much a part of chronologic age as of experiential age. Piaget believed that intelligence consists of coping with the environment.
He believed that each person must complete each stage of development before progressing to the next.
 
 
 

STAGE	APPROXIMATE AGE	EXPECTED ABILITY
SENSORIMOTOR	Birth-2 years	-Uses senses to learn about self -Schemata develops (plans for ways of learning)
PREOPERATIONAL	2-8 years	2-4 years -- thinks in mental images                       develops own language 4-8 years --  egocentrism (sees only own                       point of view)
CONCRETE OPERATIONAL	8-12 years	-ability for logical thought -moral judgment begins
FORMAL OPERATIONS	12 - adult	-develops adult logic -able to reason things out -able to plan for the future -thinks in concepts or abstracts

LAWRENCE KOHLBERG
(1927-1987)

Kohlberg believed in Piaget's theory but felt that very young people have the ability to understand right and wrong. This is why his theory is called the development of moral judgment. Kohlburg believed that these stages built on the learning achieved in the previous stage. His theory does not consider the emotional responses that daily problems and stressors can produce. Nurses are usually guided away from putting a moral value on their patients and patients' beliefs.
 
 

STAGE	"RIGHT" BEHAVIORS	WHY WE SHOULD DO "RIGHT'	WHAT IF WE DO NOT DO "RIGHT"
PRECONVENTIONAL -Punishment and obedience orientation -Concerned with having own needs met	Do not do it if it will result in a punishment	-To avoid punishment and see what one can get away with -To help me get my needs and wants fulfilled	I will be punished and I do not like that. I will lose recognition for the importance of others.
CONVENTIONAL -Good boy, good girl orientation - Law and Orders	Good means living up to what is expected. Right means obeying the rules	-Self and others think we are good -It maintains social structure	Avoiding blame is more ethical than getting a reward. Law will have less importance than the will of society
POSTCONVENTIONAL -Social contract -Universal good	Right or good is behaving according to a general consensus Universal rues of justice prevail.	-We blend together for the greatest good and welfare of all	May become aware that moral and legal may not be the same. Few people reach this according to Kohlberg therefore the stage is not measured.

The above notes are from:

Neeb, K. Fundamentals of mental health nursing, 2001, Philadelphia, F.A. Davis, 2nd Edition., Chapter 4.