Developmental Theories

Growth and Development

NRS 101
 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
 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.
 Growth and Development
Growth: Quantitative changed, measured
and compared to norms
Height, weight compared to normal
growth charts
Development: Qualitative, progressive,
continuous process of change leading to a
functional capacity
Child crawls, rolls over, walks
 Four Areas of Developmental
Theories
Biophysical-How do we grow, change, age

Psychosocial-Personality & behavior

Cognitive-Thinking, intellect

Moral-Knowing right from wrong, ethics

 Biophysical Developmental
Theories
Gesell’s Theory: Grow according to our
own genetic blueprint and pace, growth is
directed by gene activity, environmental
factors can modify pattern of development
Genetic Theory of Aging: DNA function of
cell lifespan, programmed cell death,
accounts for longevity in families
 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
 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
Erikson’s Stages of Psychosocial
Development
Trust vs. Mistrust
Autonomy vs. Shame
Initiative vs. Guilt
Industry vs. Inferiority
Identity vs. Role Confusion
Intimacy vs. Isolation
Generativity vs. Stagnation
Integrity vs. Despair
 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)
 Jean Piaget
Moral Development
Stages of moral development influenced
by environment
Observed boys, ages 5-13 yrs.
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
 Lawrence Kohlberg
Moral Development Theory
Level 1- Preconventional
Stage 1- Punish and Obey
Stage 2- Instrumental Relativist
Level 2- Conventional
Stage 3- Good boy/Nice girl
Stage 4- Society Maintenance
Level 3- Post-Conventional
Stage 5-Social Contract
Stage 6- Universal Ethics
 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
 Growth and Development
Refer to P&P pg. 173 Table 11-1 for
Developmental Age periods
Conception through adolescence
Physical growth and cognitive
development
Stages of development per age
 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)
 Newborn
Neonatal period to first month of life
P&P pg. 183 Box 11-4 for injury prevention
during infancy
 Infant
1 Month to 1 year
Health Risks: Injury prevention, child
abuse/maltreatment
Health Concerns: Nutrition, feeding,
supplementation, overfeeding, dentition,
sleep, immunizations
 Toddler
12-36 months
Health Concerns and Risks:
need for close supervision
curiosity
poisonings
auto safety
 Pre-Schooler
3-5 years
Concerns
fear of dark
fear of animals
fear of thunderstorms
fear of medical procedures
 School Age
6-12 years
Cognitive changed
Concrete operations
Mature language development
Health risks: Accidents, falls, cancer,
abduction, infections
 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
 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
 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
 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
 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
 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
 Older Adult
Physiological Changes
Skin
Head and Neck
Thorax and Lungs
Heart and vascular system
GI
Reproductive
GU
Musculoskeletal
Neuro
 Older Adult
Cognitive Changes
Delirium

Dementia

Alzheimer’s Disease

Depression
 Older Adult
Psychosocial Changes
Retirement
Social Isolation
Sexuality
Housing and environment
Death
 Older Adult
Heath Risks
90% Of adults over 65 have atleasr one health
risk
Heart disease
Cancer
CVA
COPD, Smoking cessation
Nutrition, dental problems
Arthritis
Falls
Polypharmacy
 Older Adult
Psychosocial Concerns
Therapeutic communication
Touch
Reality orientation
Validation Therapy
Reminiscence
Body Image interventions
 Older Adult
Psychosocial Concerns
Therapeutic communication
Touch
Reality orientation
Validation Therapy
Reminiscence
Body Image interventions
 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