1. Developmental Theories Growth and Development

2. Why study theory? Provides a framework Offers logic for observations and explanations How and why people act Important for nurses to combine theory, practice, and research Nurses assess responses to illness and treatments

3. Theory Organized and logical set of statements about a subject, frameworks to clarify, to make sense of. Human Development Theory: Models intended to account for how and why people become who they are, tries to explain and predict human behavior.

4. Growth and Development Growth: Quantitative changed, measured and compared to norms Height, weight compared to normal growth charts Height, weight compared to normal growth charts Development: Qualitative, progressive, continuous process of change leading to a functional capacity Child crawls, rolls over, walks

5. Four Areas of Developmental Theories Biophysical-How do we grow, change, age Psychosocial-Personality & behavior Cognitive-Thinking, intellect Moral-Knowing right from wrong, ethics

6. Biophysical Developmental Theories Nongenetic Cellular Theories: Looks at cell rather than DNA, “wear and tear” theory, our bodies just wear out. Free Radical Theory Physiological Theories of Aging: 1) Breakdown of performance of a single organ 2.) Impairment of physiological control mechanisms

7. Erik Erikson Student of Anna Freud Evolutionary process: Biological, psychological, and social events contribute to readiness for each task/stage Added 3 adult stages to Sigmund’s model

9. Erikson’s Stages of Psychosocial Development Trust vs. Mistrust - hope Autonomy vs. Shame - will Initiative vs. Guilt - purpose Industry vs. Inferiority - competence Identity vs. Role Confusion- fidelity Intimacy vs. Isolation- love Generativity vs. Stagnation-care Integrity vs. Despair-wisdom

10. Jean Piaget Cognitive Development Theory How we think, learn to reason, exercise judgment, have intellectual organization Observed children Defined 4 periods that children move through: Sensorimotor (Birth-2 yrs) Preoperational (2-7 yrs.) Concrete (7-11 yrs) Formal (11 yrs-adult)

11. Jean Piaget Moral Development Stages of moral development influenced by environment Observed boys, ages 5-13 yrs.

13. Moral Development Theories How we acquire moral values, are guided by morals, how we treat others based on morals Jean Piaget-Environmental influences Lawrence Kohlberg-Cognitive and moral linked, expanded Piaget’s work, defined 3 levels with 6 stages of moral development

15. Lawrence Kohlberg Moral Development Theory Level 1- Preconventional Stage 1- Punish and Obey Stage 1- Punish and Obey Stage 2- Instrumental Relativist Stage 2- Instrumental Relativist Level 2- Conventional Stage 3- Good boy/Nice girl Stage 3- Good boy/Nice girl Stage 4- Society Maintenance Stage 4- Society Maintenance Level 3- Post-Conventional Stage 5-Social Contract Stage 5-Social Contract Stage 6- Universal Ethics Stage 6- Universal Ethics

16. Analysis Theories give nurses some answers on why and how people react, respond as they do Human behavior is complex No one theory answers all questions All theories are multi-dimensional, not linear, they are guidelines

17. Growth and Development Conception through adolescence Physical growth and cognitive development Stages of development per age

18. Intrauterine Life 40 weeks, 9 calender months Nagele’s Rule 3 Trimesters (every 3 months) Prematurity- 20-37 weeks gestation pg. 175 Table 10-1 Tocolysis: Therapeutic interventions to stop labor before 37 weeks (IV’s, meds. Bedrest)

20. Newborn Neonatal period to first month of life P&P pg. 183 Box 11-4 for injury prevention during infancy

22. Infant 1 Month to 1 year Health Risks: Injury prevention, child abuse/maltreatment Health Concerns: Nutrition, feeding, supplementation, overfeeding, dentition, sleep, immunizations

24. Toddler 12-36 months Health Concerns and Risks: need for close supervision need for close supervision curiosity curiosity poisonings poisonings auto safety auto safety

25. Pre-Schooler 3-5 years Concerns fear of dark fear of dark fear of animals fear of animals fear of thunderstorms fear of thunderstorms fear of medical procedures fear of medical procedures

26. School Age 6-12 years Cognitive changed Concrete operations Mature language development Health risks: Accidents, falls, cancer, abduction, infections

27. School Age

28. Adolescence Teen years Ages 13-20 years Increased growth rate, sexual changes, changes in muscle and fat distribution Risks for accidents, homicide, suicide, substance abuse, tobacco use, eating disorders, sexual experimentation, pregnancy, STD’s

29. Puberty and Adolescence

31. Young to Middle Adult 20’s to 40’s Physical, cognitive, psychosocial changes Lifestyle, career, marriage, sexuality, childbearing. Infertility Risk factors for family history of disease, personal hygiene, environmental and occupational factors, family and career stress, health screenings, exercise and nutrition

32. Early Adulthood

33. Middle Adult 40’s to 60’s Menopause- Women- disruption of menstruation and ovulation, ovaries no longer produce sex hormones Climacteric- Men- decrease levels of testosterone, decrease erection/ejaculation; sperm still is produced Psychosocial Changes: career transition, sexuality, family changes Health Concerns: Stress, family diseases, forming positive health habits, anxiety, depression

34. Middle Adulthood

35. Older Adult Above 65 years Health Concerns: Chronic disease/disability, injury, decreased senses and physical strength, retirement, family changes, assisted living, grandchildren, support of other seniors, remaining independent, sexual concerns, death/dying/loss, medications, insurance coverage, memory, aging process, nutrition, hydration, skin care

36. Late Adulthood

37. Older Adult Gerontology-Geriatrics Myths and Stereotypes Theories of Aging:Stochastic (random damage over time), NonStochastic (predetermined by body mechanisms) Psychosocial Theories: Disengagement, Activity, Continuity

38. Older Adult Health services: Active adult communities, retirement communities, home care, adult day care, assisted living long term care, respite care, living with children or grandchildren

39. Older Adult Physiological Changes Skin Head and Neck Thorax and Lungs Heart and vascular system GIReproductiveGUMusculoskeletalNeuro

40. Older Adult Cognitive Changes DeliriumDementia Alzheimer’s Disease Depression

41. Older Adult Psychosocial Changes Retirement Social Isolation Sexuality Housing and environment Death

42. Older Adult Heath Risks 90% Of adults over 65 have atleasr one health risk Heart disease CancerCVA COPD, Smoking cessation Nutrition, dental problems ArthritisFallsPolypharmacy

43. Older Adult Psychosocial Concerns Therapeutic communication Touch Reality orientation Validation Therapy Reminiscence Body Image interventions

44. Older Adult Psychosocial Concerns Therapeutic communication Touch Reality orientation Validation Therapy Reminiscence Body Image interventions

45. Older Adult Acute Care Considerations Risk for dehydration, malnutrition Risk for delirium Risk for nosocomial infection Risk for incontinence Risk for falls Risk for skin breakdown