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In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of developmental stages and transitions in order to:
This section will provide you with the expected stages of growth and development for all age groups and how to modify and adjust approaches to care as based on these stages. The age groups along the lifespan and their age parameters are:
Age and developmental stages are assessed to determine if the client is at the expected level of growth and development, to plan care that is age and developmentally appropriate and to modify care as based on the age related characteristics and needs of our clients. These assessments include the physical, cognitive and psychosocial stages of growth and development. Cognitive Development: Jean PiagetJean Piaget's levels of cognitive development from birth until 12 years of age are used for the assessment of children up to this age, after which the cognitive development of the child is complete. In the correct sequential order, Jean Piaget's levels of cognitive development include:
The sensorimotor thought level has 6 sub stages; this level includes the development of the infant's and young child's ability to manipulate concrete objects.
Language and vocabulary progressively develop.
Between these ages, the child is able to use logic and reasoning; they have also developed their ability to solve concrete problems.
Under normal circumstances, the child at 12 years of age should have developed the ability to solve abstract problems and to use complex thinking, logic and reasoning. Psychosocial Development: Erik EriksonErik Erickson proposed 8 major stages of psychosocial development and expected tasks along the life span from infancy to old age. People, including our own clients, who are able to resolve their age related tasks are successfully able to progress to the next task; however, psychosocial development can become arrested when a person is not able to achieve their age related developmental task. Nurses must incorporate these developmental tasks and challenges into the plan of care and they must also modify the plan of care according to these age related tasks. Eric Erikson's stages, developmental tasks and signs of their lack of resolution are listed below. Task: Trust Failures to Resolve the Task: Mistrust and a failure to thrive Task: Autonomy, self-control and will power Failures to Resolve the Task: Shame, doubt and a poor tolerance of frustration Task: Initiative, a sense of purpose, self-confidence, and self direction Failures to Resolve the Task: The fear of punishment and guilt
Task: Industry, competence and self-confidence Failures to Resolve the Task: Feelings of inferiority and fears that one cannot meet the expectations of others Task: Identity formation and a sense of self as an individual Failures to Resolve the Task: Role confusion, lowered self-esteem and a poor self concept Task: Intimacy, love and affection Failures to Resolve the Task: Isolation and the avoidance of relationships including intimate relationships
Task: Generativity, productivity, and genuine concern for others Failures to Resolve the Task: Stagnation, self-absorption and a lack of concern about others Task: Ego integrity, wisdom and the ability to participate in life with a sense of satisfaction Failures to Resolve the Task: Despair and feelings that life is without any meaning and without any sense of satisfaction Psychosexual Development: Sigmund FreudSigmund Freud, often referred to as the father of psychotherapy, developed the concepts of id, ego and superego, the psychological defense mechanisms such as sublimation and suppression, as well as the 5 stages of psychosexual growth and development. The id is an unconscious mechanism that operates in terms of instant gratification and instant pleasure. Some say that infants are nothing more than a bundle of id. The ego is the person's sense of self that provides the person with the ability to control oneself and one's behaviors. The superego is the person's conscience. The 5 stages of Sigmund Freud's stages of psychosexual development are:
Some of the lesser known theories of growth and development include those of Stella Chess and Alexander Thomas, Roger Gould, Robert Havighurst, and Robert Peck. The Development of Temperament: Stella Chess and Alexander ThomasStella Chess and Alexander Thomas are credited with the development of the 9 temperamental qualities which include:
Roger GouldRoger Gould addresses 7 stages of growth and development that begins at age 16 and progresses to the older adult. These stages include:
Robert HavighurstThis theorist developed 6 age groups and the physical, psychological and social tasks associated with each of these 6 age groups. These age groups and their associated developmental tasks are:
Robert PeckRobert Peck's theory focuses on aging and the aging process. Robert Peck's theory has 3 developmental tasks that somewhat parallel those of Eric Erikson's phase of integrity versus despair in the later years. Robert Peck's three developmental tasks associated with aging and the aging process include:
Identifying Expected Body Image Changes Associated with the Client's Developmental AgeAs with all other nursing care, nurses must be able to identify and report client deviations from what is expected in terms of their growth and development and they must also be able to modify care and their approaches to care as based on these deviations. Nurses also determine the impact of expected body image changes on the client in terms of how the patient's perceptions are interfering with the patient's quality of life and the continued performance of their activities of daily living. Again, all maladaptation and/or poor coping skills must be determined, documented and reported so that the patient's plan of care can be changed to meet these needs. The major expected bodily changes and bodily image changes are those that occur with puberty, menopause, pregnancy and the aging process. Identifying Family Structures and Roles of Family MembersFamily structures are numerous and becoming more numerous and varied than any other time in the past. These family structures are discussed below:
Roles in the family have also changed over the past decades. In the past roles within the family were gender based; now these roles are not usually based on gender. For example, in the past the mother stayed at home and cared for the children while the father worked as the bread winner of the family. Now things are very different. For example, some males are "stay at home dads" while the female in the family works outside of the home as the bread winner of the family. Other family roles that are assumed by the adults in the family are disciplinarian, teacher, housekeeper, cook and shopper. Ideally, these roles and responsibilities are equally and equitably shared by the adults within the family unit. Like leadership styles, parenting styles also differ among members of the family when the family has one or more children. For example, parents can be permissive, democratic, participative, laissez faire and authoritarian. Comparing Client Development to Expected Age/Developmental Stage and Reporting Any DeviationsAs with all other nursing care, nurses must be able to identify and report client deviations from what is expected in terms of their growth and development and they must also be able to modify care and their approaches to care as based on these deviations. Assessing the Impact of Change on the Family SystemFamilies, like all other open systems within the environment including individual clients, are impacted with changes. Some of these changes are expected and developmentally normal and other changes are unexpected and often disruptive to the homeostasis of the family. For example, a family system can be impacted with the empty nest syndrome which is an expected and developmentally normal change; and the death of a child or a spouse is an unexpected and often disruptive change for members of the family. Families, therefore, just like individual clients, often need the care and services of the health care team to cope with any disruptive changes. Some major life changes that can significantly affect and impact on the family unit are things like poverty, homelessness, divorce, chronic illnesses and legal concerns. Families, like individual clients, often need the assistance of the nurse to cope with these changes. Recognizing Cultural and Religious influences That May Impact Family FunctioningSimilar to individual clients, families also have their own beliefs, practices, perspectives, values and views, some of which are present as the result of their culture, while others may be related to their religion and still more may just simply result from the family's personal preferences. Culture impacts on virtually all aspects of the client-nurse relationship. For example, communication patterns, beliefs about illness, who is the major family decision maker, family dynamics, perspectives about health and health care, space orientation, time orientation, nutritional patterns, beliefs about elders and the elderly, parenting, family size, and even death and death vigils are often driven by the family's culture, as passed on from generation to generation. Religious influences may also impact on the family and its functioning. Some of the same impacts that culture has, religion also has. Religion may impact on the family's beliefs about illness, nutritional patterns, beliefs about elders and the elderly, parenting, birth control, family size, and even death and death vigils are often driven by the family's religion. For example, in terms of the perideath period, some religious practices include a clergy person like a Catholic priest to perform that religion's Sacrament of the Sick. Assisting the Client to Cope With Life TransitionsThroughout the life span, there are several significant expected life transitions that require the person to cope and adjust. Some of these expected life transitions include attachment and bonding to the neonate, puberty, pregnancy, care of the newborn, parenting, and retirement. Nurses and other health care professionals assist clients to adapt to and cope with these normally occurring life transitions and changes. For example, the nurse may also seek out community resources that could be helpful to an elderly, retired person who needs transportation to and from doctor's appointments, a nurse could teach the new mother and their partner about how to bond and attach to the newborn, and the nurse could also conduct newborn care classes for new parents to assist these new person to cope with the challenges associated with the care of a neonate and infant. Modifying Approaches to Care in Accordance with the Client's Developmental StageAs somewhat previously discussed with the "Integrated Process: Communication" and the "Integrated Process: Teaching and Learning", communication and teaching are modified according to the client's age, level of cognition, and developmental stage. Physical care, including medication administration, as will be discussed later in this review, is also modified according to the client's age and developmental status. Some of these modified approaches to care, communication, explanations, teaching and diversionary activities include:
Providing Education to the Client and Staff Members About Expected Age-Related Changes and Age-Specific Growth and DevelopmentClients and staff members must be knowledgeable and educated about expected age related changes and age specific characteristics and needs. Registered nurses can identify knowledge deficits and assess learning needs among staff members by observing how well and how consistently their nursing care is modified according to their clients' age specific characteristics and needs. Similarly, registered nurses can identify knowledge deficits and assess the learning needs among their clients and family members across the life span in terms of their knowledge about expected age related changes and age specific characteristics and needs. For example, neonates and infants receive communication with the touch or a coo by an adult and they enjoy colorful things like a mobile; infants and toddlers must not be given any small toys or toys that can disassemble into small parts because they are in the oral stage of development where they place objects in the mouth which places them at risk for aspiration and death; adolescents are rebellious and they want to be with and accepted by their peers. Adults enjoy socialization and activities like different sports and an exercise regimen; and older adults may be in need of activities such as those in an elder day care center and reminiscence therapy. When a staff or client/family learning need is assessed, the nurse then plans, implements and evaluates the teaching that is given specific to the learners' needs. For example, a middle aged man caring for an elderly parent may have the need to learn about the safety needs of the elderly and new parents may need education related to age appropriate toys and car seats. Evaluating the Client's Achievement of Expected Developmental Level and MilestonesWhen nurses assess clients they incorporate their knowledge of developmental levels into this assessment to determine and evaluate whether or not the client is achieving the expected milestones associated with their age. As previously detailed, these assessments include the clients' assessment of their physical growth and development, their psychosocial growth and development, their cognitive growth and development, and their psychosexual growth and development. Determining the Impact of Expected Body Image Changes on the ClientIn addition to the physical aspects of body image changes, there are also social and emotional impacts with these changes. With the support of the health care team, the client should be able to adapt to the changes, alter his or her life style as indicated, discard irrational beliefs and replace these with realistic expectations, maintain social interactions, and enhance the bodily image with things like a breast prosthesis and a wig, for example. Evaluating the Impact of Expected Body Image Changes on the Client and FamilyBody image changes such as those associated with aging, pregnancy, menopause, disfiguring surgery, and others place challenges upon the client and the family in terms of coping and adaptation. Some of the signs that indicate whether or not the client is coping with altered bodily image include the client's acknowledgment of the changes as well as verbal and nonverbal comments about the change. Providing Education to the Client and Staff Members About Expected Age-Related Changes and Age-SpecificGrowth and DevelopmentStaff members must be educated about the age related changes and the age specific characteristics and needs of clients across the life span so that they can modify the care of their client's accordingly. Clients should also be educated about the age related changes and the age specific characteristics and needs of different age groups as necessary. For example, a young mother may be taught about her toddler's age appropriate toys and a middle age adult may have a need to learn about depression among the elderly when the parents are not coping with the normal changes of the aging process. Evaluating the Impact of Expected Body Image Changes on the Client and FamilyNurses also determine and evaluate the impact of expected body image changes on the client and family in terms of how their perceptions and beliefs may be interfering with the patient's quality of life and the continued performance of their activities of daily living. Again, all maladaptation and/or poor coping skills must be determined, documented and reported so that the patient's plan of care can be changed to meet these needs. Some of the most stressful expected body image changes that may adversely affect the client and family include body image changes such as those associated with pregnancy, menopause, puberty, and aging. These changes may occur with significant reactions and responses in terms of the person's physical, psychological and social wellbeing. RELATED CONTENT: SEE – Health Promotion & Maintenance Practice Test Questions Latest posts by Alene Burke, RN, MSN (see all) |