ncs1201 Foundations of Nursing

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NCS1201 Foundations of Nursing
Foundations of Nursing (Edith Cowan University)
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NCS1201 Foundations of Nursing
Week 1: Health, Wellness and Social Determinants
Definition of health
• Health is a ‘state of complete physical, mental and social wellbeing, not merely the absence
of disease or infirmity” (WHO, 1974)
• ‘Health depends on our ability to understand and manage the interaction between human
activities and the physical and biological environment. (WHO, 1992)
Definition of wellbeing
• Wellbeing:
o A critical component of health
o Is a subjective feeling of health
o A sense of enjoyment, of happiness, and fulfilment
• Wellness:
o Living life at maximum potential and in harmony with the particular circumstances of
one’s life (Dunn, 1977)
o “The process of incorporating behaviours into your daily life to positively impact your
health’ (Robinson and McCormick, 2011:31)
Health can be socially and culturally defined

• People’s Charter for Health states that health is a social, economic and political issues and
above all a fundamental human right
• Inequality, exploitation, violence and injustice are at the root of ill health
Alma-Ata Declaration (WHO 1978)

• The Alma-Ata Declaration called for an end to health inequality in and between countries
“health for all the people of the world by the year 2000 (WHO, 1978)
Ottawa Charter (WHO 1986)

• The Ottawa Charter for health (WHO, 1986) followed the Alma-Ata Declaration (WHO,
1978) which reaffirmed the “health for all” target
• The Ottawa Charter suggested that there were ‘prerequisites for health’
o Peace, shelter
o Education, food
o Income
o Social justice and equity
o Stable eco-system
o Sustainable resources
What is a determinant of health?

• Any factor or characteristic that impacts health, positive or negative
• Social and economic environment, physical environment
• Persons individual characteristics and behaviours
Concepts of health equity, inequity and inequality

• Equity is broadly about the more or less equal distribution of goods and services usually
based on need
• Inequities arise from the way people experience those conditions or factors that determine
health
• Inequality is the term used to designate the measurable differences, variations and
disparities in the health achievements of individuals and groups

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Define social determinants of health

• The conditions in which people are born, grow, live, work and age
o Neighbourhood
o Family
o Education
o Access to healthcare
Biological and hereditary factors

• Biological factors
o Advancing age
o Chronic disease status
o Dietary habits
• Hereditary factors
• Genetic constitution
o BRCA1 and 2 genes
o Epigenetics
Gender and Early Childhood

• Females do not have equal access to health, education or adequate nutrition and rest in
some countries or cultures
• Poor nutrition, use of drugs, use of alcohol and poor prenatal care lead to poor
development with long term effects in emotional, physical and cognitive health into
adulthood
Environmental – Food and clean water

• Poor nutrition leads to susceptibility to disease and illness including but not exclusive to:
o Cardiovascular disease
o Diabetes
o Anaemia
o Reduced cognition
o Typhus, cholera, etc.
o Diarrhoea
Environmental – Culture and social support

• Culture influences a persons response to wellness and illness
• Western health care is a biomedical model which may conflict with other cultures e.g.,
Chinese, Aboriginal, Muslim
How employment can affect health

• Improved economic status
• Workplace stress
• Workplace injury, illness
• Gender bias
• Job insecurity
How unemployment can affect health

• Increase in stress
• Increased mortality
Education
• Enables individuals to realise their full potential
• Enables societies to reach their full potential
• Enables social competence
• Associated with improved opportunities

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Poor education
• Decreases individuals opportunities
• Reduces societies ability to reach its full potential
• Associated with decrease in opportunity
Stress
• Stress is an unavoidable component of day to day life
• Physical – chemical, biological, microbiological
• Psychological
• Economic
• Cultural
• Physiology of stress
Addiction
• A chronic relapsing condition characterised by compulsive behaviours and abuse
• A response to social breakdown
• Associated with markers of social and economic disadvantage
• A financial drain on income
Steps in identifying health needs

• Examination of indicators of personal health
• Understanding the client’s health beliefs
• Linking people’s information with known health risks for their population group
• Community assessment, exploring available resources and barriers to health
Consider how the social determinants of health work together rather than in isolation to
inform us of health outcomes
• Social determinants combine to influence health along multiple dimensions. Income affects
neighbourhood, which affects school choice, which affects education.
o Socioeconomic position
o Wealth inequality
o Social cohesion
o Ethnicity
o Gender
Identify how social determinants influence health

• Where you live affects everything from community resources to whether you can exercise
safely to your daily access to healthy food
• Learning about health, diet and exercise influences your health
• Strong family bonds are a protective health factor
• For some medical conditions, race and ethnicity can affect how patients will fare
• Early childhood care shapes the trajectory for lifelong health
• The greater one’s income, the lower one’s likelihood of disease or premature death
• Health disparities negatively impact people of colour in spite of annual income and
education level through discrimination
• Mental health is an area where bias and stigma keep people from seeking care
• Environmental hazards affect health (pollution, drinking water)
Explore different levels of healthcare

• Primary
o Ways to intervene to keep people healthy
o Health promotion and health education – promoting healthy lifestyles (nutrition,
exercise in schools)

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o Health protection – immunisation, safety programs, environmental protection

• Secondary
o Intervening to help those ill or injured
o Detect health risks early and screen for early signs of disease
o Screening programs, case finding, examination and treatment of disease
• Tertiary
o Working to find ways of restoring and rehabilitating people in ways that reduce
relapse of illness or further injury
o Comes into effect once disease or injury is obvious
o Restoration and rehab, hospital and community care facilities
What is the Closing the Gap campaign?

• Federal Government initiative to address disadvantages between ATSI and other
Australians in respect to infant mortality, life expectancy, access to education, employment
outcomes
Explore your own culture and ethnicity (including your identity, attitudes, beliefs,
behaviours) and how these affect nursing practice
• Be aware of your own cultural background/experiences, attitudes, values, and biases that
might influence your ability to assist clients from diverse cultural populations.
• It is essential that you correct any prejudices and biases you may have regarding different
cultural groups.
• Educate yourself wherever possible to enhance your understanding and to address the
needs of culturally diverse clients. This may involve learning about cultural, social,
psychological, political, economic, and historical material specific to the particular ethnic
group being served.
• Recognise that ethnicity and culture may have an impact on a patient’s behaviour
• Respect the client’s religious and/or spiritual beliefs and values
• Work to eliminate biases, prejudices, and discriminatory practices
• Provide information in a language that the patient can understand
• Provide information in writing, along with oral explanations
Discuss how nurses can address health inequalities and social injustice
• By reducing inequality between individuals, nurses can improve health outcomes for those
individuals
Define culture
• The ideas, customs, and social behaviours of particular people or society
Define cultural safety

• How people are treated in society
• Aimed at reducing the impact of cultural dominance and power disparities that can occur
between health professionals and the patients or clients
• Every person should have access to care that acknowledges them as an individual
Define person centred-care

• Culturally appropriate care
• Individual to that persons needs
• Occurs with respect
• Negotiated process between nurse and the patient

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Define terminology associated with a socio-ecological approach to health

• All life factors affect health of individuals
• Cultural, environmental, socioeconomic, lifestyle factors
What is the Social Gradient?

• Poor people are less healthy than rich people
• Greater the gap, the greater the differences in health
• Less control = more stress, less choice
• Poorer conditions
• Physical vulnerability
• Vicious circles
The most significant predictor of health in Australia is income.
Define the following

• Burden of disease
o Burden of disease is a measure of population health that aims to quantify the gap
between the ideal of living to old age in good health, and the current situation where
healthy life is shortened by illness, injury, disability and premature death.
• Comorbidity
o The presence of one or more additional diseases co-occurring with a primary
disease or disorder
• Epidemiology
o The study of incidence and distribution of diseases
• Health determinant
o A factor or characteristic that affects health
• Incidence
o The occurrence, rate, or frequency of a disease, crime, or other undesirable thing
• Mortality
o The rate of death in a population
• Morbidity
o The rate of disease in a population
• Negative determinant of health

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o A factor or characteristic that negatively impacts health

• Positive determinant of health
o A factor or characteristic that positively impacts health
• Prevalence
o Prevalence is the proportion of a population who have a specific characteristic in a
given time period.
• Social determinants of health
o The conditions in which people are born, grow, live, work and age
• Socioeconomic status
o Socioeconomic status (SES) is an economic and sociological combined total
measure of a person's work experience and of an individual's or family's
economic and social position in relation to others, based on income, education, and
occupation.
• Social cohesion
o Defined as the willingness of members of a society to cooperate with each other in
order to survive and prosper
Week 2: Client Education and Health Promotion
What is the purpose of client education?

• To enable patients and families to learn how to manage health problems and achieve
health
• Three main purposes:
o Maintenance and promotion of health and illness prevention
▪ Through risk modification:
• Adopting a healthy lifestyle
• More exercise
• Immunisation
• Health screening
▪ Recognise cultural influence and social determinants to match education
o Restoration of health
▪ Patients recovering from physical or psychological illness/disease
▪ Put in place educational opportunities to take ownership of illness and
recovery
o Coping with impaired functioning
▪ People who do not fully recover from illness need to learn to cope with illness
• E.g. Diabetes – blood glucose level management
What is health promotion?

• Promotion of health combines all efforts that seeks to move people to optimum health and
wellbeing and wellness
• Improving the health or raising the health status of individuals, groups, communities, cities
and countries
• Strategies include health teaching and information sharing, motivating behavioural change,
global health promotion (WHO)
• Concept based on the value that health, quality of life, extension of life can be realise
through particular strategies
• Highlights/recognises importance of social determinants of health
• Three main goals:
o Increase lifespan and quality of life for all citizens
o Reduce health disparities among population groups
o Achieve access to preventative services

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What is the concept of health improvement?

• Measurable improvement in health status and social wellbeing in individual or population,
attributable to an earlier intervention
• Must be attributable (proven result of an intervention)
• Intervention must be a planned activity
• E.g. Education of obese patient, who lost weight due to intervention. Link objectives to
results
The Three Pillars of Health Promotion

• The primacy of people
o Uniqueness/individuality
o Specific to social determinant
• Empowerment
o Using our power to work with people to achieve wellbeing
• Enabling
o Having skills, knowledge and competencies to achieve health advancement
How can we work well with individuals, families, groups and communities?
• Establish partnership relationship to engage with them in health promotion
• They may be vulnerable population groups (women, children, aged, homeless, culturally
sensitive)
• Show cultural competence
What is teaching and learning?

• Teaching
o Interactive process that promotes learning
• Learning
o Purposeful acquisition of new knowledge, attitudes, behaviours and skills
• Two-way process of communication between nurse and client
What is the nurse’s role in teaching and learning?

• Ethical responsibility to share information with client
• Contextual
o Teaching and learning must match situation and client (same as communication
used)
• Anticipatory guidance
o Teach how to prevent unwanted events from occurring, and prepare them for
anticipated events
o E.g. Client had general anaesthetic, nurse informs them when they try to get up they
might be dizzy, will need assistance to get up, to prevent falling
• Teaching process is a communication process
• Learning objective may be identified

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What is Bloom’s Taxonomy?

• Theory of learning mastery
• Important in teaching and learning
What are Bloom’s Taxonomy learning domains?

• 3 learning domains
• Cognitive (knowledge – split into more categories)
o Low level processes – acquisition of knowledge
o Middle level processes – comprehension, application, analysis
o High level processes – evaluation and creation
• Affective (attitude)
o How you react emotionally to a skill
• Psychomotor (skills)
o How you physically perform a skill
Cognitive domain in detail

• Skills revolve around knowledge, comprehension, critical thinking on a particular topic
• Learning theory attempts to explain human behaviour by understanding thought process
• 6 levels – domain proceeds from simple to complex
o 1 – Knowledge
▪ Person can recall new knowledge, information and facts
o 2 – Comprehension
▪ Person demonstrates understanding of facts and knowledge they have
obtained
o 3 – Application

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▪ Knowledge comprehended is used to solve problem, person can apply new

knowledge to specific situation and new situation
o 4 – Analysis
▪ Ideas related in organised way – important information identified – entry point
to critical thinking
o 5 – Synthesis
▪ Ability to recognise parts of information, can then modify information to use to
predict an outcome
o 6 – Evaluation
▪ Judgement of worth of information – used to evaluate outcomes
Affective domain in detail

• Skills to describe the way people react emotionally
• Affective objectives target awareness and growth in attitudes, emotion, feelings, values,
opinions
• Proceeds from simple to complex
o 1 – Receiving
▪ When receiving another person’s word, there is active participation through
respectfully listening
o 2 – Responding
▪ Reacting verbally or non-verbally to the heard/read word
o 3 – Valuing
▪ Attachment of worth to an object or behaviour
o 4 – Organisation
▪ Developing a value system by recognising and organising values
o 5 – Characterisation by value
▪ Using the value system to manage/regulate behaviour

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Psychomotor domain in detail
• Skills to describe the ability to physically manipulate a tool or instrument

• Psychomotor objectives focus on change and/or development in behaviour and/or skills
• Acquisition of skills require integration of mental and muscular activity
• Ranges from simple to complex
• Perception
o Awareness. Ability to use sensory cues to guide motor activity
• Set
o Readiness to act. Includes mental, physical, emotional sets. They predetermine a
persons response to different situations
• Guided response
o Early stages in learning complex skill. Includes imitation, trial and error. Adequacy of
performance achieved by guided practice.
• Mechanism
o Learned responses have become habitual, movements/skill performed with
confidence/proficiency
• Complex over response
o Skilful performance of motor acts, involves complex movement patterns. Indicated by
quick, accurate, highly coordinated performance requiring minimal effort/energy.
Includes automatic performance
• Adaptation
o Skills well developed, can modify movement patterns to fit special requirements
• Origination
o Creating new movement patterns to fit particular situation/problem. Learning
outcomes emphasise creativity based on highly developed skills
Learning principles: Motivation to learn

• Attentional set
o Patient must have the ability to pay attention and learn
o Can be affected by pain, anxiety, altered cognition
• Motivation
o The drive or desire to achieve goals
o The client needs to be ready to learn
o The client must be self-motivated
• Use of theory
o Application of learning theory matched to persons needs
• Psychosocial adaption to illness

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o May need to go through grieving process to adapt to illness. Stages are:

▪ Denial/disbelief
▪ Anger
▪ Bargaining
▪ Resolution
▪ Acceptance
• Active participation
o Eagerness to acquire knowledge or skills
o Improves opportunity for client to make informed decisions after the education
session
• Language barriers
Learning principles: Ability to learn

• The ability to comprehend; to understand and to benefit from experience
• Influenced by physical and developmental capability
• Different learning styles (Kolb’s – Diverging, Assimilating, Converging, Accommodation)
• Developmental capability
o Cognitive development – how it influences us to learn
o Assess intellectual ability to ensure achievable goals set
o Literacy/numeracy skills assessment
o Age
• Physical capability
o Dependent on:
▪ Level of coordination/sensory acuity
▪ Physical developmental and physical health
▪ Strength, coordination, hearing, eyesight
▪ Pain or medications can impact and impair
• Learning environment – creating the optimum environment
o Physical – consider the number of people being taught
o Privacy, comfort, lighting, ventilation, noise, layout of room
o Teaching aids, engaging instructor
• Learning styles
o Kolb’s Theory for the way people like to learn
▪ Diverging – Feeling and watching. Groups
▪ Assimilating – Watching and thinking. On own
▪ Converging – Doing and thinking. Solve problems
▪ Accommodation – Doing and feeling. Hands on. Use instinct
Factors important when developing Learning Objectives

• Ability to learn
• Assess current knowledge
• Readiness to learn
• Timeframe
• Language
• SMART goals
What is Banduras theory of self-efficacy?

• If the person has confidence – they are more likely to do and achieve
How does the nursing process compare with the teaching process?
• Relationship exists – but not the same
• Nursing – requires assessment of all sources of data to determine clients total healthcare
needs
• Teaching – focuses on clients learning needs and ability to learn

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How does the nursing process integrate with the teaching process for patients?
• Assessment
o Assess all areas influencing the situation
▪ Expectations of learning
▪ Learning needs
▪ Motivation to learn
▪ Ability to learn (including developmental capacities)
▪ Teaching environment
▪ Resources for learning
• Nursing Diagnoses (problem statement)
o Problem statement to reflect the specific learning need
o Ensure goal-directed and individual
o Often knowledge deficit (affective, cognitive, psychomotor)
• Planning
o Prioritise teaching topics
o Content – from simple to complex (Bloom’s Taxonomy)
o Appropriate timing (when, length)
o Active participation (encourage)
o Senses – multiple – hearing, visual (any deficits)
o Build on prior knowledge
o Provide resources
• Implementation
o Implementing the teaching
o Teaching approaches
▪ Telling, selling, participating, entrusting, reinforcing
o Incorporating teaching with nursing care
o Instructional methods – 1:1, group, demos – depend on time, setting, resources,
learning need
o Speaking the clients language – developmental stage, sensory deficits, age
o Using teaching tools
o Special needs – children (motivation), elderly
• Evaluation
o Ongoing appraisal of clients learning process
o Goal – have they learnt what you taught them
o How to evaluate – ask to demonstrate, ask questions, talk with family on how well
they are performing learnt task, take measurements (weight, blood glucose)

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Define the following terms:
Affective learning
• Growth in feelings or emotional areas
Cognitive learning
• Mental skills (knowledge)
Psychomotor learning
• Manual or physical skills
Learning objective
• Statements that define the expected goal of a course or lesson that will be acquired by a
person as a result of instruction/education
Developmental capacity
• Cognitive development – how it influences us to learn
• Assess intellectual ability to ensure achievable goals set
• Literacy/numeracy skills assessment
• Age
Teaching methods
• A teaching method comprises the principles and methods used by teachers to enable
student learning.
• Strategies are determined partly on subject matter to be taught and partly by the nature of
the learner
Teaching and routine nursing care

• Hygiene
• Medication management
• Mental health/group therapy
Identify methods for evaluating learning

• Demonstration of what they’ve been taught
• Asking specific questions to skills they should have learnt
• Measurements against guidelines (e.g. blood glucose)
• Feedback from client or discuss with family
• Keep a diary
• Observation
• Quizzes for testing knowledge
Documentation of teaching and learning activity

• Legal requirement to document
• Date/time/accuracy
• Determines progress or lack of progress
• Medical history/social history
• Avoid repetition
• Continuity of care
Week 3: Critical Thinking and Developmental Theories
Lifespan Development
• Main Development theory used in healthcare

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What is Critical Thinking?

• Affects patient safety directly
• Complex skill – process of conceptualising, applying and problem solving
• Based on informed decisions
• Based on reflection, reasoning and communication
Ockhams Razor
• Problem solving principle
• Simplest one is best
• Don’t make assumptions
• “Among competing hypotheses, the one with the fewest assumptions should be selected”
What Are The Components of Critical Thinking?

• Gathering and seeking information
• Using a wide range of sources proactively not reactive
• Questioning and investigating – not just accepting information given
• Challenge and seek deeper meaning
• Analysis, evaluation and inference – examine information, put into context, understand and
link information together to make complete decisions
• Problem solving and application of theory
• Consider the bigger picture, be reflective, predict upcoming situations and know what to do
next
5 Tips to Improve Critical Thinking

• Formulate your question
• Gather your information
• Apply the information
• Consider the implications
• Explore other points of view
Clinical Reasoning
• A learnt skill which requires active engagement and practice/reflection to improve
performance
• Central to clinical practice
• Positive impact on patient outcomes
What are Clinical Judgement/Reasoning Skills?

• Challenging assumptions – don’t assume
• Reflecting on experience
• Questioning one’s usual way of thinking – keeping an open mind
• Promoting patient safety through the process of clinical judgement and decision making is
crucial to the delivery of high quality patient care
What Do You Need to Develop Critical Thinking Skills?

• Sound knowledge base
• Ability to notice clinical signs, interpret observations, respond appropriately
• Ability to reflect on actions taken
• Value client experiences as stepping stones
• Initially problems are either right or wrong, with time and more complex problems, use
logical thought processes to analyse and examine alternatives
• Eventually able to anticipate the need to make choices, actions are decided independently
and accountability is assumed

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Factors Affecting Critical Thinking Skills

• Students
• Educators
• Education System
• Atmosphere/Environment
Factors Promoting Critical Thinking Skills
• Questioning
• Reflective writing
• Case-based interventions
Framework for Critical Thinking
Importance of Life Span Development

• Development: the pattern of movement or change that begins at conception and continues
through the human life span
• Life Span Approach: emphasises developmental change throughout childhood, adulthood
and old age
The Nature of Development
• Biological
o Changes in an individual’s physical nature
• Cognitive
o Changes in thought, intelligence and language
• Socioemotional
o Changes in relationships with other people, changes in emotions and changes in
personality
• Moral
o Learning what ought to be – or not

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Developmental Periods
• Developmental changes are a result of biological, cognitive and socioemotional processes
The Life Span Perspective

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Concept of Age
• Chronological age
• Biological age
• Psychological age
• Social age
Developmental Issues
• Nature vs nurture
• Stability vs change
• Continuity vs discontinuity
Theories of Development
• Five theoretical orientations to development
o Psychosocial/analytic
o Cognitive
o Behavioural and social cognitive
o Ethological
o Ecological
Psychosocial Theory of Development
• Psychosocial/analytic
o Freud’s psychoanalytical theory (1856-1939)
▪ 5 stages from birth to adulthood
o Erikson’s psychosocial theory (1902-1994)
▪ 8 stages from birth to adulthood
Cognitive Theory of Development
• Cognitive
o Jean Piaget (1896-1980)
▪ How we think
▪ How people learn to think and make sense of their world
▪ 4 periods of development
▪ Children move through these periods at different rates but in the same order
▪ Number of stages within each period
o Vygotsky’s sociocultural cognitive theory (1896-1934)

▪ Children actively construct their knowledge
▪ Emphasises how social interaction and culture guide cognitive development
▪ Learning is based upon the inventions of society

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Moral Theory of Development

• How individuals acquire moral values and how such values help guide the way those
persons treat other people
• Piaget’s moral development theory
o Two stages: heteronomous morality and autonomous morality
• Kohlberg’s moral development theory
o Found a link between moral development and Piaget’s cognitive development
Behavioural Theory of Development
• Behavioural and social cognitive theories
o Bandura’s social cognitive theory
▪ Behaviour, environment and cognition are key factors in development
▪ Observational learning: learning through observation
o Skinner’s operant conditioning
▪ Consequences of a behaviour produce changes in the probability of the
behaviours’ occurrence
▪ A reward increases likelihood of behaviour
▪ A punishment decreases likelihood of behaviour
Summary of Week 3
• Life span development involves change throughout all of life
• Development is influenced by biological, cultural and individual factors and made up of a
combination of biological, cognitive and socioemotional processes
• Age can be described/calculated in different ways such as chronological, biological,
psychological or social age
• The main issues around development involve debates over nature vs nurture, stability vs
change and continuity vs discontinuity
Define the following terms
Critical thinking
• Purposeful, self-regulated, judgement. Critical thinking has been defined as ‘weighing up
the arguments and evidence for and against’ (Cottrell, 2008 as cited by Whiffin &
Hasselder, 2013. P.831) and described as the process of raising questions, defining
problems, gathering and assessing information and coming to well- reasoned conclusions
after looking at all alternatives (ISNA, 2015).
Scientific method
• Four step approach used to obtain accurate information
• 1. Conceptualise problem
• 2. Collect data
• 3. Draw conclusions
• 4. Revise research conclusion and theory
Theory
• An interrelated, coherent set of ideas that helps to explain and make predictions
Hypothesis
• Specific assumptions and predictions that can be tested to determine their accuracy
Psychoanalytic theories
• Describe development as primarily unconscious and heavily coloured by emotions.
Behaviour is merely a surface characteristic and the symbolic workings of the mind have to
be analysed to understand behaviour.

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Life span
• This means how long humans can live for
Life expectancy
• The average number of years that a person can expect to live
Chronological age
• The number of years you have lived for.
Biological age
• The functional capacity of a person’s vital organs. The younger your biological age, the
longer you are expected to live, regardless of chronological age.
Psychological age
• Refers to a person’s adaptive capacities, compared to other people of the same
chronological age. This is related to areas such as motivation, positive outlook on life,
control of emotions and flexibility which are seen to me adaptive behaviours.
Social age
• Refers to social roles and expectation's related to a person’s age
Week 4: Family Centred Care

Defining the Family
• Many variations
• No single universal definition
• ABS defined family as:
o Two or more persons, one of whom is aged 15 years or over, who are related by
blood, marriage (registered or de facto), adoption, step or fostering; and who are
usually resident in the same household
Family Functions
• Maintaining wellbeing and a sense of belonging to individuals in the family group
• Raising children
• Establishing group values
• Sharing financial and material resources
• Passing on knowledge of the culture and values of the group to the next generation
• Healthcare providers
Family Structures
• Nuclear family
• Couple-only family
• Extended family
• Single-parent family
• Blended family
• Alternative patterns of relationship
• Same-sex marriage
Current trends & New Family Forms

• Family size is getting smaller
• Most people will marry, although later
• Most stay married to their first partner
• Women are delaying childbirth

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• Most children are still born into and grow up in a family with two resident parents
• Children are staying at home longer
• More people live alone
• Men and women are living longer
• Indigenous/migrant families may have less social support from their elders than other
families
• Single-parent families are steadily increasing
• Same-sex couples are creating family units
• Fastest growing age group is 65 years and older
Theories, Models and Family Nursing

• Family systems theory
o Views family as a whole system
o Considers how individuals within the system interact
o What happens affects the entire family
• Family development theory
o Family has a life cycle
o Roles and structure of family change throughout lifespan
o Family achieves milestones
• Family cycle of health and illness model
o Members influence each other’s health habits
o Focus on family decisions about health and healthcare
• Structural functional theory
o Supports social structure and network
• Family stress theory
o Analysis how families cope with stressful events
Functional vs Dysfunctional Family

• Functional family
o Stable unit
o Consistent rules
o Promotes wellbeing of members
o Resilient and competent
• Dysfunctional family
o No consistency of members or rules
o Poor interpersonal relationships
o Deals poorly with conflict
Family Centred Care

• Definition
o An approach to the planning, delivery, and evaluation of health care that is grounded
in mutually beneficial partnerships among health care providers, patients, and
families …that shapes policies, programs, facility design, and staff day-to-day
interactions
• Four key principles underpinning approach:
o Respect and dignity
o Information sharing
o Participation
o Collaboration
Family Nursing
• The approach to family nursing is determined by who we are working with, the nature of
their health, and in which context nursing care takes place
• Three approaches:

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o Family as context
o Family as client
o Family as system
• Family nursing process model
o Assessment of the family
o Analysis of family story
o Develop family plan of care
o Family intervention
o Family evaluation
o Nurse reflection
Influence of Family on Lifestyle

• Development of healthy lifestyle
• Family members are role models
• Attitude toward exercise and food
• Healthy relationships
• Cultural practices and beliefs
Define the terms:

Family
• Two or more persons, one of whom is aged 15 years or over, who are related by blood,
marriage (registered or de facto), adoption, step or fostering; and who are usually resident
in the same household
Family System Theory

• A theory of human behaviour that views the family as an emotional unit and uses systems
thinking to describe the complex interactions in the unit
• It is the nature of a family that its members are intensely connected emotionally
Family Developmental Theory

• Family development theory focuses on the systematic and patterned changes experienced
by families as they move through their life course
Functional Family
• One in which family members work together to improve relationships as they face
challenges
Dysfunctional Family
• A family in which conflict, misbehaviour, and often child neglect or abuse on the part of
individual parents occur continuously and regularly, leading other members to
accommodate such actions
Week 5: Childhood
Growth Versus Development

• Growth
o The quantitative changes that can be measured and compared with norms
• Development
o Implies a progressive and continuous process of change leading to a state of
organised specialised functional capacity
Conception & Prenatal Development

• Conception & Prenatal development (38-40 weeks)

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o Germinal/embryonic/foetal period
• Teratogen: any agent that can cause a birth defect
Prenatal Development
• Prenatal care
o Health promotion
o Screening for manageable conditions and treatable diseases
o Educational, social and nutritional services
• Childbirth
o 95-96% in hospitals
o Birth centres and home deliveries
Transition from Intrauterine to Extrauterine Life at Birth

• Physical changes
o Independent respiratory function
• Psychosocial changes
o Parent-child interactions begin
• Health considerations
o Airway patency
o Immature immune system
o Thermoregulation
Physical Changes of the Newborn

• Neonatal period = first month of life
o Average weight 3400g, 50 cm in length, head circumference of 35 cm
o Heart rate ranges from 120-160 bpm
o Average blood pressure is 74/46 mmHg
o Abdominal breathing, rate of 30-50 bpm
o Head moulding and fontanelles
o Elimination
Reflexes
• Cognitive changes:
o Innate behaviours and reflexes
Reflex Stimulation Response Duration

Babinski Sole of foot stroked Fans out toes and twists Disappears at 9 months to
foot in a year
Blinking Flash of light or puff of air Closes eyes Permanent
Grasping Palms touched Grasps tightly Weakens at three months;
disappears at a year
Moro Sudden move; loud noise Startles; throws out arms Disappears at 3 – 4
and legs and then pulls months
them toward body
Rooting Cheek stroked or side of Turns toward source, Disappears at 3 – 4
mouth touched opens mouth and sucks months
Stepping Infant health upright with Moves feet as if to walk Disappears at 3 – 4
feet touching ground months
Sucking Mouth touched by object Sucks on object Disappears at 3 – 4
months
Swimming Placed face down in water Makes coordinated Disappears at 6 – 7
swimming movements months
Tonic neck Placed on back Makes fists and turns head Disappears at 2 months
to the right

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Cognitive Changes of the Newborn: Senses

• Touch
o Sensitive to touch on mouth, palms and soles
o Highly sensitive to pain
• Hearing
o Can hear sound at birth, learns sound patterns within days
o Sensitive to voices, hearing test at birth
• Vision
o Visual structures in the eyes not fully formed
o Limited acuity, tract movement and monitor environment
• Taste and Smell
o Prefer sweet tastes & have odour preferences at birth
o Can identify mother through smell
Psychosocial Changes of the Newborn

• Psychosocial changes
o Strong bonds develop
o Needs to be priority of care planning
o John Bowlby – attachment theory
▪ Newborns maintain contact with parent
• Health considerations
o Hyperbilirubinaemia – jaundice
o Inborn errors of metabolism (IEMS) testing
o Post natal depression
Physical Changes of Infancy

• Infancy = 1 month old to 1 year old
• Physical changes:
o Rapid physical growth and psychosocial development
o Norm-referenced percentile charts
o Interact with their environment
o Increased capacity for bodily movements
o Gross motor skills develop
o Delays in achievement of expected milestones may indicate a degree of
developmental delay
o Sleep patterns may change
Physical Changes of Infancy: Motor Development

• Gross motor skills: large-muscle activities
o The development of posture
o Learning to walk
• Fine motor skills: finely tuned movements
o Reaching and grasping
o Palmer grasp: grasping with the whole hand
o Pincer grip: grasping with the thumb and forefinger
Physical Changes of Infancy: Sensation and Perception

• Vision
o Interest in human faces, colour vision, depth perception
• Hearing
o Sensory threshold higher
• Touch and pain
o Respond to touch and can also feel pain

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• Smell
o Can differentiate odours
• Taste
o Sensitivity to taste may be present before birth
Cognitive Changes of Infancy: Piaget

• The Sensorimotor Stage: infant cognitive development lasting from birth to 2 years
o Infants construct an understanding of the world by coordinating sensory experiences
with physical, motoric actions
o Divided into sub-stages
▪ Reflexes cause actions
▪ Repeats pleasing actions
▪ Makes interesting actions last
Cognitive Changes of Infancy: Remembering and Conceptualising

• Conditioning
o Classical and operant conditioning versus information retention
• Attention
o The focusing of mental resources on select information
• Memory
o Retention of information
• Imitation
o Imitate expression
Typical Age Language Milestones

Birth Crying
2 – 4 months Cooing begins
5 months Understands first word
6 months Babbling begins
7 – 11 months Changes from universal linguist to language-specific listener
6 – 12 months Uses gestures, such as showing and pointing
Comprehension of words appears
13 months First word spoken
18 months Vocabulary spurt starts
18 – 24 months Use two-word utterances
Rapid expansion of understanding of words
Cognitive Changes of Infancy: Language

• Child-directed speech
o Language spoken in a higher pitch than normal with simple words and sentences
▪ Captures infant’s attention and maintains communication
Psychosocial Changes of Infancy
Emotion
• Emotional expression and social relationships
o Emotions permit coordinated interactions with caregivers
o Fear is one of a baby’s earliest emotions
o Stranger anxiety: infant shows a fear and wariness of strangers
o First appears at about 6 months of age, intensifies at about 9 months of age
Temperament
• Gender, culture and temperament
o Parents may react differently to an infant’s temperament depending on gender
o Different cultures value different temperaments
• Goodness of fit concept

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o The match between a child’s temperament and the environmental demands the child
must cope with
Erikson’s Theory
• Personality development
o Trust: Erikson believed the first year is characterised by trust versus mistrust
▪ Not completely resolved in the first year of life
▪ Arises again at each successive stage of development
Social Referencing
• Reading ‘emotional’ cues in others to determine how to act in a particular situation
o Mother’s facial expression influences infant’s behaviour
Attachment
• Close emotional bond between two people
o Erikson: Trust arises from physical comfort and sensitive care
o Bowlby: Biologically equipped to attach
o Ainsworth’s Strange Situation is an observational measure of infant attachment
o Secure, avoidant, resistant, disorganised
o Maternal sensitivity linked to secure attachment (secure base)
Health Considerations of Infancy

• Accidental Injury
• Injury prevention
• Death in infancy
o Congenital abnormalities
o Prematurity, infection and respiratory problems
o SIDS
• Immunisation
• Maltreatment
• Nutrition and feeding practices
• Dentition
Learning Capacity & Teaching Methods

• Learning Capacity
o Relies on parents for basic needs
o Learns to trust adults when convey love
o Explores environment through senses
• Teaching Methods
o Keeps routines consistent
o Hold firmly, smile and speak softly
o Stimulate senses
Physical Changes of Toddlers

• Toddlerhood = 12 – 36 months
o Height and weight
▪ 9 cm in height & quadruple their weight
▪ Growth patterns vary individually
o Sphincter control
o Gross motor skills: crawling, walking, jumping, running
o Fine motor skills: reaching, grasping, scribbling, drawing
o Cultural variations in motor development
Physical Changes of Toddlers: Brain

• Brain growth slows during early childhood
o Brain reaches 95% of adult volume by 6 years of age
• Changes in child’s brain structure

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o Increased myelination
o Rapid, distinct spurts of growth especially in the frontal lobes
o Stimulation is vital
Cognitive Changes of Toddlers: Piaget

• The Preoperational Stage
o Ages 2 to 7 years
o Children represent the world with words, images and drawings
o Begin to problem solve
o Cognition is dominated by egocentrism and magical beliefs
o Moral development begins
o Deferred imitation
Cognitive Changes of Toddlers: Language

• Play make-believe together
• Have frequent conversations
• Read often and talk about books
Psychosocial Changes of Toddlers: Emotions

• Social Referencing
o Relying on other’s emotional reactions to appraise situation
o Caregivers can use examples/lessons to teach children how to react
• Self consciousness
• Emotional self regulation
Psychosocial Changes of Toddlers: Temperament

• Balance between reactivity and self-regulation
• Combine genetics, environment and gender
• Child-rearing to match temperament
• Shy versus sociable child
• Goodness of fit concept
• Temper tantrums
Psychosocial Changes of Toddlers: Erikson

• Autonomy versus shame and doubt
o Sense of autonomy emerges
o Encourage appropriate independence to avoid doubt
o Firm, consistent limits, patience and support
• Play
o Solidary play
o Moving towards parallel play
Psychosocial Development of Toddlers: Attachment

• 4 Stages of attachment
o Pre-attachment
o Attachment-in-the-making
o Clear-cut attachment
▪ Separation anxiety
o Formation of a reciprocal relationship
• Cultural variations
• Multiple attachments
Health Considerations

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• Safety
o Falls and other injuries
o Cars
o Drowning
o Burns
o Poisoning
o Choking
o Strangers
• Nutrition
• Child abuse

• Learning Capacity of Toddlers
o Learns words and express feelings
o Learns by associating words with objects
o Likes to explore through play
o Use play to teach
o Offer picture books
o Use simple words to promote understanding
Physical Changes of Pre-Schoolers

• Gain 2-3 kg per year, grow 6-7.5 cm per year
• Gross motor skills
o Skipping, skipping rope
o Swimming
• Fine motor
o Improved eye-hand coordination
o Dressing and feeding
o Intricate drawings
Cognitive Changes of Pre-Schoolers

• Piaget: Preoperational stage
o Cannot reason logically yet
o No concept of conservation
o Egocentric
o Moral development
• Language development
o About 2000 words by age 5
o Asking many questions (Why? How?)
• Fear of bodily harm
• Make-believe play
Cognitive Changes of Pre-Schooler: Vygostky’s Sociocultural Theory

• Social contexts
o Other people contribute to cognitive development
• Zone of Proximal Development
o Tasks child cannot do alone but can learn with help of more skilled partners
Cognitive Changes of Pre-Schoolers

• Information processing
o Attention: improves significantly
o Memory: becomes more accurate
o Strategies and problem solving

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▪ Strategies: deliberate mental activities to improve the processing of

information
▪ Early childhood transforms the toddler into a child capable of flexible, goal-
directed problem solving
Psychosocial Changes of Pre-Schoolers

• Surplus of energy
• Expanding world
• Erikson
o Initiative versus guilt
o Eager to tackle new tasks
o Overstepping limits
o Wrong behaviour
• Can discuss feelings to some degree
• Emerging empathy
Health Considerations of Pre-Schoolers

• Safety, MVA
• Less falls
• Poisonings
• Injuries
• Nutrition
• Immunisation
• Sleep
• Child abuse (maltreatment or neglect)

• Learning Capacity of Pre-Schoolers
o Uses language without comprehending meaning
o No concept of time
o Expresses feelings through actions rather than words
o Asks questions
o Use role-play, imitation and play to make it fun to teach
o Offer simple explanations and demonstrations
o Learn through pictures and short stories
Physical Changes of School-Age Children

• Middle childhood = 6 to 12 years old
o Postural changes
o Growth slows ready for puberty
o Facial bones grow and remodel
o Permanent teeth erupt
• The Brain
o Significant changes in structures and regions occur, especially in the prefrontal
cortex
o Activation of some brain areas increase while others decrease (synaptic pruning)
• Motor Development
o Motor skills become smoother and more coordinated
o Improvement of fine motor skills is due to increased myelination of the CNS
o Boys outperform girls in large muscle activities
o Girls outperform boys in fine motor skills
• Exercise
o Television watching is linked with low activity and obesity in children

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o Exercise linked to cognitive development
Cognitive Changes of School-age Children: Piaget’s Theory

• Concrete operational stage: ages 7 – 11 years
o Starts to reason logically
o No abstraction yet
o Understands concept of conservation
o Not just own perceptions of world
Cognitive Changes of School-age Children

o Memory: long-term memory increases with age
o Thinking
▪ Critical thinking
▪ Creative thinking
▪ Scientific thinking
▪ Metacognition: cognition about cognition
• Language development
o Vocabulary increases, about 3000 by age of 6
o Use words more precisely
o Similar advances in grammar skills
o Can verbalise pain and some health needs
• Limitation
o Might not tell you as afraid of consequences
Moral Changes of School-age Children

• Kohlberg’s 3 levels and 6 stages of moral development

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Psychosocial Changes of School-age Children

• Self-concept and self-esteem
o Self-concept: evaluations of the self
o Self-esteem: global evaluations of the self
▪ Identify causes of low self-esteem
▪ Provide emotional support and social approval
▪ Help child achieve & cope
o Self-efficacy: belief that one can master a situation and produce favourable
outcomes
o Perspective taking and empathy
• Peers and Friends
o Reciprocity becomes increasingly important in peer interchanges during primary
school
o Peers become increasingly important
• Bullying
o Verbal or physical intended to disturb someone less powerful
o Outcomes of bullying
▪ Depression, suicidal ideation and attempted suicide
▪ More health problems
Psychosocial Changes of School-age Children: Erikson

• Industry versus inferiority
o Industry: children become interested in how things work
o Inferiority: parents who see their children’s efforts as mischief may encourage
inferiority
o Develop sense of competence
o Pride in accomplishment
o Self-esteem emerges
Psychosocial Changes of School-age Children: Families

• Developmental changes in parent-child relationships
o Parents spend less time with children during middle and late childhood
o Parents support and stimulate children’s academic achievement
o Important to maintain a structured and organised family environment
o Parents use less physical forms of punishment as children age
Health Considerations: Child Maltreatment

• Physical, sexual or emotional abuse and neglect
• Factors related to maltreatment
o Parent characteristics
o Child characteristics
o Community
o Culture
• Consequences of maltreatment
o Serious emotional, learning and adjustment problems
Health Considerations: Prevention of Child Maltreatment

• Training parents, families, communities
o Social support
o Child abuse services WA
o Crisis care
o Ngala Family Resource Centre
o Grandcare
o Family helpline
o Kids helpline

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o Parenting helpline
• Separating families that cannot change
Health Concerns of School-age Children

• Health, illness and disease
o Usually a time of excellent health
o Accidents and injuries
▪ Motor vehicle accidents are most common cause of severe injury
o Overweight children
▪ Prevalence of Australian and New Zealand children who are overweight or
obese is high
o Cardiovascular disease
o Nutrition, sleep and stress
School-age Children with Disabilities

• The Scope of Disabilities
o Learning disabilities
o Attention deficit hyperactivity disorder (ADHD)
o Emotional and behavioural disorders
o Autism spectrum disorders (ASD)

• Learning Capacity of School Children
o Acquires ability to relate events and actions to mental representations
o Is able to make judgments
o Play becomes more formal and social
o Asks many questions about health
o Teach Psychomotor skills to maintain health
o Offer opportunities to discuss health problems and answer questions
Define the terms

Joint Attention
• Joint or shared attention is the shared focus of two individuals on an object
• It is achieved when one individual alerts another to an object by means of eye-gazing,
pointing or other verbal or non-verbal indications
Child Directed Speech

• Various speech patterns used by parents or caregivers when communicating with young
children, particularly infants, usually involving simplified vocabulary, melodic pitch, repetitive
questioning, and a slow or deliberate tempo
Temperament
• Temperament broadly refers to consistent individual differences in behaviour that are
biologically based and are relatively independent of learning, system of values and attitudes
Attachment
• Attachment is a deep and enduring emotional bond that connects one person to another
across time and space
Social Referencing
• A process where the infant cues from other people in the environment, about which
emotions and actions are appropriate in a certain context or situation
• Infants observe the behaviour of others and emulate their actions and behaviours

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Deferred imitation
• Watching someone perform an act and then performing that action at a later date
• Taken from the words defer and imitate, it is a means of learning that Jean Piaget observed
in children
Egocentrism
• Egocentrism is the inability to differentiate between self and other
• It is the inability to untangle subjective schemas from objective reality and an inability to
understand or assume any perspective other than one’s own
Concept of conservation
• Conservation refers to logical thinking ability
• According to Piaget, is not present in children during the preoperational stage of their
development at ages 2-7, but develops in the concrete operational stages at ages 7-11
Self-concept
• An idea of the self which is constructed from the beliefs one holds about oneself and the
responses of others
Self-esteem
• Self-esteem reflects an individual’s overall subjective emotional evaluation of his or her own
worth. It is the decision made by an individual as an attitude towards the self
Week 6: Adolescence
Preadolescence
• The transitional period between childhood and adolescence
• Beginning of the second skeletal growth spurt
• Develop pubic hair
• Changes in sexual characteristics
• Develop close social networks of both same and opposite sex
Physical Changes of Adolescence

• Adolescence = 13 to 20 years old
o Transition from childhood to adulthood
o Psychological maturation
o Development of primary and secondary sexual characteristics
o Physical changes are cause by hormones
o Height and weight increase during the prepubescent growth spurt
Physical Changes of Adolescence: Brain

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Physical Changes of Adolescence: Sexuality

• Adolescent sexuality
o Developing a sexual identity involves
▪ Learning to manage sexual feelings
▪ Developing new forms of intimacy
▪ Learning skills to regulate sexual behaviour
o Sexual identity includes:
▪ Activities
▪ Interests
▪ Styles of behaviour
▪ Indication of sexual orientation
o Same-sex attractions
Physical Changes of Adolescence: Gender differences
Boys Girls
Growth Spurt Starts age 12 ½ Starts age 10
Proportions Shoulders broaden, longer legs Hips broaden
Muscle-fat makeup Gain more muscle, aerobic efficiency Gain more fat
Physical Changes of Adolescence: Sexual Maturation of Girls

• Girls – growth spurt and breasts bud
• Menarche occurs around 12.5 – 13 years, but the age range is wide (10.5 – 15.5 years)
• Pubic hair and breast development occur, then underarm hair appears
• Normally takes 3 – 4 years to complete
• Ovaries may not produce mature ova for 12 – 18 months following primary menarche, this
temporary sterility does not occur in all girls
Physical Changes of Adolescence: Sexual Maturation of Boys

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• First sign: enlargement of the testes, accompanied by changes in the colour and texture of
the scrotum
• Pubic hair emerges a short time later and the penis begins to enlarge (peak at 14 years)
• Underarm, facial and body hair also emerge just after the peak in body growth and
gradually increase for several years
• The voice deepens as the larynx enlarges and the vocal cords lengthen
Reactions to Puberty
Physical Changes of Adolescence: Sleep Habits

• Still need almost as much sleep, but go to bed later
o Biological ‘phase delay’
o Social habits
• Lack of sleep impairs regulation of attention, emotion
o Lower achievement
o Mood problems
o High-risk behaviours
Cognitive Changes of Adolescence

• Piaget’s Theory
o Formal operational stage (age 11+ years)
▪ More abstract than concrete operational thought
▪ Increased verbal problem-solving ability
▪ Increased tendency to think about though itself
▪ Thoughts of idealism and possibilities
▪ More logical thought
• Adolescent Egocentrism
o Heightened self-consciousness of adolescents
▪ Imaginary audience: adolescents’ belief that others are as interested in them
as they themselves are
▪ Personal fable: involves a sense of uniqueness and invincibility
▪ Invincibility attitudes
• Information Processing
o Executive functioning
▪ Higher-order cognitive activities such as reasoning, making decisions, thinking
critically and monitoring one’s cognitive process
o Decision making
o Critical thinking
Psychosocial Changes of Adolescence

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• Self-Esteem
o Self-esteem is the overall way we evaluate ourselves
o Controversy over whether or not self-esteem changes during adolescence of if there
are gender differences in adolescents’ self-esteem
o Narcissism: a self-centred and self-concerned approach towards others
• Erikson’s Psychosocial Theory
o Identity versus role confusion
o Psychosocial moratorium: the gap between childhood security and adult autonomy
o Adolescents experiment with different roles and personalities
o Adolescents who cope with conflicting identities emerge with a new sense of self
o Adolescents who not successfully resolve the identity crisis suffer identity confusion
• Parent-Child Relationships
o Rise in conflict
▪ Adaptive behaviour
▪ Psychological distancing
▪ Different view of teen readiness for responsibility
o Most conflict is mild
▪ Also affection, support
• Friendships
o Fewer “best friends”
o Peer pressure & groups
o Stress intimacy, loyalty
▪ Closeness, trust, self-disclosure
o Friends are similar
▪ Identity status
▪ Aspirations
▪ Politics
▪ Deviant behaviour
• Emotions
o Moodiness
o More negative life events
o Stronger responses
o Mood swings – related to daily events
o Depression
o Suicide
• Emotional Problems
o Internalising problems – emotional problems are manifested inwards and individuals
harm themselves (eating disorders, self-mutilation, overuse of drugs, depression
o Externalising problems – emotional problems that are manifested outwards, when
people act out by injuring others, destroying property or defying authority (more
common in boys; deliberate accidents, provoked homicides, violent deaths)
Health Considerations of Adolescence

• Accidents remain the leading cause of death
• Male and indigenous suicide
• Nutrition – obesity and eating disorders
• Mental health – males tend to be narcissistic, females tend to lack self-esteem
• Sleep
• Sexuality
o Experimentation
o Contraception
o STDs
o Teenage pregnancy
• Substance abuse
Learning Capacity of Adolescents

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• Wants to be in control – fears loss of self-concept

• Is able to solve abstract problems
• Learns best when immediate benefit is gained
Teaching Methods of Adolescents

• Help learn about feelings and need for self-expression
• Allow to make decisions about health and promotion
• Use problem solving to help make choices
Define the terms

Androgens
Anorexia
Binge Drinking
High Risk Behaviour
Oestrogen
Testosterone
Week 7: Young and Middle Adulthood
Physical Changes of Young Adults

• Usually quite active and do not experience severe illnesses
• Tend to ignore symptoms
• Growth completed by 20 years
• Changes in the brain
o Prefrontal cortex of the brain is fully developed
o Critical and rational thinking habits increase
• Physical performance and development
o Peak physical performance typically occurs between ages 19 and 26
o Muscle tone and strength usually begin to show signs of decline around age 30
Physical Changes of Young Adults: Sexuality

• Sexual activity in emerging adulthood
• Those who had been in a relationship for 12 months of longer had sex on average 1.84
times a week
• Majority report having sex important to well being
• Same-sex couples: acceptance growing
• Many gender differences that appear in heterosexual relationships occur in same-sex
relationships
Cognitive Changes of Young Adults

• Piaget’s Theory
o Adolescents and adults think qualitatively in the same way (formal operational stage)
▪ Young adults are more quantitatively advanced because they have more
knowledge than adolescents
o Individuals consolidate their formal operational thinking during adulthood
▪ Many adults do not think in formal operational ways at all
• Realistic and Pragmatic Thinking (Labouvie-Vief)
o As adults face the constraints of reality, their idealism decreases
• Reflective and Relativistic Thinking (Perry)
o Adults think in favour of reflective, relativistic ways
• Theory of Fifth, Post-formal Stage
o Post-formal thought – more reflective judgement, solutions to problems can vary,
emotions can play a role in thinking

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Moral Changes of Young Adults

• Kohlberg’s View:
o Post conventional level (III)
o Move away from decisions based on authority or conformity
o Start to define own moral values and principles
▪ Stage 5 – Social contract orientation
▪ Stage 6 – Universal ethical principle orientation
Psychosocial Changes of Young Adults

• Young adults must make many decisions
o Lifestyle: greatest threat to health
o Career: ensures economic security, can cause career-related stress
o Sexuality: increased emotional maturity
o Relationships: single, partners, marriage, parents
• Single Adults
o Dramatic rise in the past 30 years
o Common problems:
▪ Forming intimate relationships with other adults
▪ Confronting loneliness
▪ Finding a place in a society that is marriage-oriented
• Married Adults
o Benefits of a good marriage
▪ Happily married people live longer, healthier lives
▪ Feel less physical and emotional stress
• Attachment
o Secure attachment style
▪ Have a positive view of relationships and find it easy to get close to others
o Avoidant attachment style
▪ Are hesitant about getting involved in romantic relationships
o Anxious attachment style
▪ Demand closeness and are less trusting, more emotional, jealous and
possessive
Psychosocial Changes of Young Adults: Erikson

• Intimacy versus isolation
o Intimacy – making a permanent commitment to intimate partner
o Involves giving up some new independence, redefining identity
o Affects friendships, work
o Isolation – loneliness, self-absorption
o Hesitant to form close ties
o Fear of losing identity
Psychosocial Changes of Young Adults: Childbearing

• Becoming a parent
o Parenting myths and reality
▪ The birth of a child will save a failing marriage
▪ The child will think, feel and behave like the parents did in their childhood
▪ Patenting is an instinct and requires no training
o Current trends
▪ Fewer children
▪ Maternal age rising
Ten Hallmarks of Emotional Health

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• A sense of meaning and direction in life

• Successful negotiation through transitions
• Absence of feelings of being cheated or disappointed by life
• Attainment of several long-term goals
• Satisfaction with personal growth and development
• When married, feelings of mutual love for partner; when single, satisfaction with social
interactions
• Satisfaction with friendships
• Generally cheerful attitude
• No sensitivity to criticism
• No unrealistic fears
Health Considerations of Young Adults: Risk Factors

• Family history
• Obesity
• Violent death and injury
• Substance abuse
o Smoking and nicotine – smoking is linked to 30% of cancer deaths, 21% of heart
disease deaths and 82% of chronic pulmonary disease deaths
o Alcohol – Binge drinking, alcoholism
o Drugs – marijuana, stimulants, prescription, party drugs, ice epidemic
• Domestic violence
• Unplanned pregnancies
• Sexually transmitted infections
• Environmental or occupational factors
Health Consideration of Young Adults: Health Promotion

• Health promotion
• Infertility
• Exercise
• Routine health screening
• Acute care
• Restorative and continuing care
Physical Changes of Middle Adulthood

• Early to mid-30’s to late 60s
• Physical changes:
o Occur between 40 and 65 years
o May affect self-concept and body image
o Menopause and climacteric
o Vision, hearing, skin and body changes
o Muscle:fat makeup
o Mineral content of bone declines
Physical Changes of Middle Adulthood: Climacteric

• Sexuality
o Climacteric – the midlife transition in which fertility declines
o Menopause – time in middle age (late 40s to early 50s) when a woman’s menstrual
periods completely cease
▪ Perimenopause – transitional period; often takes up to 10 years
▪ Heredity and experience influence the onset of menopause
o Hormonal changes in middle-aged men
▪ Modest decline in sexual hormone level and activity
▪ Erectile dysfunction: inability to achieve and maintain an erection

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o Sexual attitudes and behaviour

▪ Sexual activity occurs less frequently than in early adulthood
▪ Middle-aged men are more interested in sex than middle-aged women
Cognitive Changes of Middle Adulthood

• Piaget’s Theory: Formal Operational Stage
o Increased realistic, pragmatic and reflective thought
o Decline rare, unless illness of trauma occurs
o Can learn new skills and information
• Crystallised intelligence
o An individual’s accumulated information and verbal skills
o Experience, good judgement, wisdom
o Continues to increase in middle adulthood
• Fluid intelligence
o The ability to reason abstractly
o Working memory, the speed at which you can process information
• Information Processing
o Speed of information processing
▪ Perceptual speed begins declining in early adulthood and continues to decline
in middle adulthood
o Expertise
▪ More evident in middle adulthood than in early adulthood
▪ Rely on accumulated experience
▪ Process information automatically and analyse it more efficiently
▪ Have better strategies and shortcuts to solving problems
▪ Are more creative and flexible in problem solving
Psychosocial Changes of Middle Adults

• Expected or unexpected events
• Career transition
• Sexuality
• End of fertility for females
• Family types and transitions
o Relationship change
o Care of ageing parents
Psychosocial Changes of Middle Adults: Erikson

• Generativity • Stagnation
• Reaching out to others in ways that give • Place own comfort and security above
to and guide the next generation challenge and sacrifice
• Commitment that extends beyond self • Self-centred, self-indulgent, self-
absorded
• Often realised through child rearing • Lack of involvement or concern with
young people
• Other family, work, mentoring • Little interest in work productivity, self-
relationships also generative improvement
Psychosocial Changes of Middle Adulthood

• Midlife Crisis
• Research: wide individual differences
• Gender differences
o Men – midlife
o Women – early adulthood
• Sharp disruption uncommon

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• Differences in handling regrets

o Changes or not
o Interpretation, acceptance
• Burnout
• Result of long-term job stress
o Overload, common in helping professions
• Linked to:
o Mental exhaustion, attention and memory problems
o Loss of control, depression
o Physical illness
o Reduced sense of accomplishment
o Poor performance, absenteeism, turnover
• Relationships
• Many people have more close relationships than in any other period of life
• Love and marriage
• Children – “launching” and “empty nest syndrome”
• Parents and siblings
• Friends
• Grandparenting
Health Considerations of Middle Adulthood

• Stress and stress reduction
• Levels of wellness
• Positive health habits
• Psychosocial concerns – anxiety, depression, suicide1
• Community health programs
• Cardiovascular disease
o Responsible for 25% of middle-aged deaths
o Symptoms
▪ Heart attack
▪ Arrhythmia
▪ Angina pectoris
o Risk conditions
▪ High blood cholesterol
▪ Atherosclerosis
▪ High blood pressure
• Cancer
• Acute and restorative care
o Recovery from an injury or illness may take longer
o Acute illness may become chronic
o Chronic illnesses affect roles and responsibilities
o The degree of disability and the client’s perception of both the illness and the
disability determine the lifestyle changes that will occur
Middle Adulthood Learning Capacity & Teaching Methods

• Learning Capacity
o Comply because fear of results
o Information must be valued
o Encourage participation by setting mutual goals
o Encourage independent learning
o Inform about effects of health problem

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Week 8: Late Adulthood
Young, Old and Oldest

• Distinctions based on age, health and social well-being
o Young-old – health and vigorous, financially secure, active in family and community
life
o Old-old – have major physical, mental or social losses, but still have some strengths
o Oldest-old – dependent on others for almost everything
• Some gerontologists like the following terms better
o Optimal aging
o Usual aging
o Impaired aging
Biological Theories of Aging

• Free Radical Structure Theory
o Unstable oxygen molecules produce errors in cell maintenance and repair, leading to
a range of disorders
• Wear and Tear Theory
o Body wears down because of accumulated exposure to inadequate nutrition,
disease, pollution and other stresses
• Cellular Accidents or Mutation Theory
o Accumulation of minor accidents that occur during cell reproduction cause aging
• Cellular Clock Theory (Hayflick Limit)
o Cells stop replicating at a certain point
• Hormonal Stress Theory
o Lower resistance to stress increases likelihood of disease
• Immune System Theory
o Decline in functioning gives rise to infectious diseases
Physical Changes of Late Adulthood

• In normal aging all major body systems slow and become less efficient, eventually causing
death
o Alteration in overall body height, shape and weight
o With weight loss may come muscle loss, reduction in flexibility
• Exercise/physical activity is beneficial
o Helps maintain strength of heart muscle and lungs
o Improves overall quality of life
o Lack of exercise can lead to heart attack
• Primary Aging
o Genetically influenced declines
o Affects all members of species
o Even happens if health is good
• Secondary Aging
o Declines due to hereditary and environment
o Effects individualised
o Major contributor to frailty
o Illnesses and disabilities: arthritis, diabetes, injuries, mental disabilities
Physical Changes of Late Adulthood: Appearance and Mobility

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• Skin thinner, rougher, wrinkles, spotted

• Ears, nose, teeth and hair change
• Lose height and weight after 60
• Muscle strength declines
o 10-20% by 60-70
o 30-50% by 70-80
• Bone strength decreases
• Less flexibility
• Vision
o Only about 10% of elderly see well
o Lower visual acuity
o Poor dark adaptation, sensitivity to glare
o Decreased colour, depth perception
o Cataracts, glaucoma, macular degeneration
• Hearing
o Declines as result of reduced blood supply & cell death
o Presbycusis – age-related hearing loss
o Tinnitus – buzzing or ringing
o More common than visual impairment
o Compensation, not passive acceptance, is crucial
o Adjustment to changes
o Critical factor is recognition of the problem and willingness to change
• Taste
o Reduced sensitivity to basic tastes
o Food less enjoyable
o Increasing likelihood of deficiencies
• Smell
o Decrease in number of smell receptors
• Touch
o Decline often not dramatic
o Crucial for visually impaired
• Pain
o Less sensitive to pain
o May mask conditions that should be treated
Physical Changes of Late Adulthood: Aging Systems of the Body
• Cardiovascular/Respiratory
o Heartbeat less forceful; slower heart rate, blood flow
o Vital lung capacity cut by half
o Less oxygen to tissues
o Exercise helps
• Immune
o Effectiveness declines
o More infectious, autoimmune diseases
o Stress-related susceptibility
• Nervous System
o Loss of brain weight & neuron accelerates after 60
o Autonomic nervous system less efficient
o Brain can compensate:
▪ New fibres, neurons, connections
▪ Use more parts of brain

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o Secondary aging – several diseases impair cognition: dementia, hypertension.

Diabetes, arteriosclerosis
o Lifestyle habits contribute to these diseases: poor eating, smoking, lack of exercise
Physical Changes in Late Adulthood: Sexuality & Sleep

• Sexuality
o Still important – less desire and frequency
o Married couples – regular and enjoyable sex, continue patterns
o Problems – men sometimes stop all activities if erection problems
o Cultural influences – disapproval in West
• Sleep
o Difficulty falling asleep and staying asleep
o Take more naps, feel drowsy during the day
Cognitive Changes in Late Adulthood

• Impairment not inevitable consequence of ageing!
• Structural and physiological changes occur
• Conditions affecting cognition
o Delirium
o Dementia
o Depression
o Speed of processing declines often due to a decline in brain and central nervous
system functioning
o Attention
▪ Selective attention – older adults are generally less adept at this
▪ Divided attention
▪ Sustained attention
• Problem solving changes
• Factors related to cognitive change
• Memory changes during ageing
o Episodic memory – younger adults have better episodic memory
o Semantic memory – does not decline as drastically as episodic memory
▪ Exception – tip of the tongue phenomenon
o Working memory – declined during late adulthood
o Prospective memory – remembering something in the future
• Language processing
o Comprehension changes very little
o Problems retrieving specific words
▪ Tip of the tongue, pauses in speech
o Problems planning what to say
▪ Hesitations, false starts, repetition
o Compensation
▪ Simpler grammar
▪ More sentences
▪ Gist
Factors Related to Cognitive Change
• Mentally active life
• Health status strong predictor

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• Retirement
• Distance to death
• Lifelong learning
Psychosocial Changes in Late Adulthood
• Changes in roles and relationships
• Reminiscence, personality and wellbeing
• Social theories of ageing
Erikson’s Theory
Ego Integrity Despair

• Feel whole, complete, satisfied • Feel many decisions were wrong,
with achievements but now time is too short
• Serenity and contentment • Bitter and unaccepting of coming
• Associated with psychosocial death
maturity • Expressed as anger, contempt
for others
Reminiscence and Life Review
Reminiscence Life Review

• Telling stories about people, • Considering the meaning of past
events, thoughts and feelings experiences
from past • A form of reminiscence
• Self-focused: can deepen • For greater self-understanding
despair • Can help adjustment
• Other-focused: solidifies
relationships
• Knowledge-based: helps solve
problems
Psychosocial Changes in Late Adulthood: Personality

• Self-esteem
o Tends to decline
o 70’s – 80’s
• Older adults in society
o Stereotyping older adults: ageism
o Abuse
Psychosocial Changes in Late Adulthood: Relationships
• Social Convoy
• Marriage
• Divorce, remarriage, cohabitation
• Widowhood
• Never-married, childless older adults
• Siblings
• Friendships
• Relationships with adult children/grandchildren
Psychosocial Changes in Late Adulthood: Successful Ageing
• Adjusting to decreasing health and physical strength
• Adjusting to retirement and reduced or fixed income

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• Adjusting to death of a spouse

• Accepting self as ageing person
• Maintaining satisfactory living arrangements
• Redefining relationships with adult children
• Finding ways to maintain quality of life
Health Considerations in Late Adulthood: Maximising Potential

• Being physically active
• Remaining mentally active
• Eating a varied fat-controlled diet
• Managing stress effectively
• Avoiding physical insults to the body
• Ensuring adequate rest and sleep
• Preventing infections and diseases
Risk Factors in Late Adulthood

• Falls
• Physical inactivity
• Obesity
• High blood cholesterol
• Inadequate intake of fruit and vegetables
• Smoking
• Excessive alcohol consumption
Key words
Prospective memory
Reminiscence
Ageism
Biological theories of ageing
Primary ageing
Secondary ageing
Frailty
Working memory
Theorists MCQ & short answers. Freud. Erikson. Piaget, Kohlberg

Fluid and crystallised intelligence
Social determinants
Teaching and learning process versus nursing process
Primary, secondary, tertiary health education

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Case Scenario Mary Smith

Mary Smith is, a 54-year aboriginal woman who has been a widow for 5 years, she is unemployed
and has lived in Halls Creek, Western Australia all her life. She has experienced a myocardial
infarction (heart attack).
Choose WA all regions and locate Halls Creek. Note down the statistics.
Now choose WA Metro and locate Cottesloe and note and compare the statistics with those from
Halls Creek and discuss why they are different.
Identify the 6 social determinants that may have impacted on Mary’s health status.
Issues – access to healthcare, lives alone, social support in local community, family support
available, access to transport, access to shopping/groceries, cardiac rehabilitation availability in
remote areas

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NCS1201 Foundations of Nursing

Foundations of Nursing (Edith Cowan University)

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NCS1201 Foundations of Nursing

Week 1: Health, Wellness and Social Determinants

Health can be socially and culturally defined

Alma-Ata Declaration (WHO 1978)

Ottawa Charter (WHO 1986)

What is a determinant of health?

Concepts of health equity, inequity and inequality

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Define social determinants of health

Biological and hereditary factors

Gender and Early Childhood

Environmental – Food and clean water

Environmental – Culture and social support

How employment can affect health

How unemployment can affect health

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Steps in identifying health needs

Identify how social determinants influence health

Explore different levels of healthcare

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o Health protection – immunisation, safety programs, environmental protection

What is the Closing the Gap campaign?

Define cultural safety

Define person centred-care

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Define terminology associated with a socio-ecological approach to health

What is the Social Gradient?

The most significant predictor of health in Australia is income.

Define the following

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o A factor or characteristic that negatively impacts health

Week 2: Client Education and Health Promotion

What is the purpose of client education?

What is health promotion?

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What is the concept of health improvement?

The Three Pillars of Health Promotion

What is teaching and learning?

What is the nurse’s role in teaching and learning?

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What is Bloom’s Taxonomy?

What are Bloom’s Taxonomy learning domains?

Cognitive domain in detail

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▪ Knowledge comprehended is used to solve problem, person can apply new

Affective domain in detail

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Psychomotor domain in detail

• Skills to describe the ability to physically manipulate a tool or instrument

Learning principles: Motivation to learn

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o May need to go through grieving process to adapt to illness. Stages are:

Learning principles: Ability to learn

Factors important when developing Learning Objectives

What is Banduras theory of self-efficacy?

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Define the following terms:

Teaching and routine nursing care