EM2019334 Describe each theorist’s point of view and establish the relevance to nursing

 

Describe each theorist’s point of view and establish the relevance to nursing
Biophysical Development All biophysical theories attempt to describe the ageing process. No one theory offers a complete explanation. Is concerned with physical changes over time.	Cognitive theories (Vygotsky’s social cultural cognitive theory & information processing theory) Vygotsky places importance on social interaction and culture in influencing cognitive development. His theory is seen as a sociocultural cognitive theory – ie social interaction with more mature and skilled members of society  Information processing focuses on the ability of people to manipulate information, monitor it and stategise about it. It does not see development as stage like as Piaget did, but suggests that individuals develop gradually in their ability to process information which enables them to develop increasingly complex knowledge and skills.
Freud (Psychosexual Development) One of the key concepts of Sigmund Freud’s approach to psychology (or the ‘psychodynamic approach’) is that the psyche is split into three separate entities. These entities are the ‘id’, the ‘ego’ and the ‘superego’, with the first and last being largely unconscious. The id is the childlike side of our personality that’s driven by its sex drive and desire for gratification, food and warmth. This is then kept in check by the ego and the superego, with the superego being the opposite of the id – a highly controlling and anxious entity that seeks to act in a socially acceptable manner, almost like a conscience. The ego is then trapped somewhere in the middle. These are the ‘oral’, ‘anal’, ‘latency’ and ‘genital’ stages, where the child seeks stimulation from of these areas. For example, Freud believed that during the anal stage children derive enjoyment from excretion. It is then said that should if the child should experience serious trauma at this age they will become ‘fixated’, retaining the characteristics they had at that age. For example, an ‘anal’ personality might develop if the parents are too strict with their toilet training, resulting in a personality that is strict with tidiness and gets anxious if something is out of place. Again ‘anal personality’ is a term that’s found its way into our everyday vocabulary.	Piaget (Cognitive & Moral Development) Cognitive development Cognitive development refers to the manner in which people learn to think, reason and use language. Cognitive development represents a progression of mental abilities from illogical to logical thinking from simple to complex problem solving and from understanding to concrete ideas and understanding abstract concepts. Suggested that there are four general periods of development with a number of stages within each. Children move through each period but at different rates but in the same sequence. The Sensorimotor Stage: During this stage, infants and toddlers acquire knowledge through sensory experiences and manipulating objects. The Preoperational Stage: At this stage, kids learn through pretend play but still struggle with logic and taking the point of view of other people. The Concrete Operational Stage: Kids at this point of development begin to think more logically, but their thinking can also be very rigid. They tend to struggle with abstract and hypothetical concepts. The Formal Operational Stage: The final stage of Piaget's theory involves an increase in logic, the ability to use deductive reasoning, and an understanding of abstract ideas. It is important to note that Piaget did not view children's intellectual development at a quantitative process; that is, children do not just add more information and knowledge to their existing knowledge as they get older. Instead, Piaget suggested that there is a qualitative change in how children think as they gradually process through these four stages. A child at age 7 doesn't just have more information about the world than he did at age 2; there is a fundamental change in how he thinks about the world. Moral development - Piaget described a two-stage process of moral development Pre-moral* (0 to 3 years) The child has little concept of morality or rules.   Heteronomous morality* or moral realism (4 to 10 years) - The child’s moral reasoning is governed by external rules laid down by others.  Basically they believe in expiatory punishment, i.e. the naughtier the behaviour the greater the punishment should be and in immanent justice, the idea that if a child is naughty they will suffer for it somehow.  Autonomous morality* or moral relativism (10 years onwards) - The child now has a more flexible view of rules and morality.  Crucial differences include the idea that the punishment should be tailored to fit the crime and the ideas that it is intentions rather than consequences that determine the severity of the crime.
Erikson (Psychosocial Development) Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud's theory of psychosexual stages, Erikson's theory describes the impact of social experience across the whole lifespan. One of the main elements of Erikson's psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experiences and information we acquire in our daily interactions with others.   Erickson’s theory: Eight stages over the course of his or her life. Influenced by Freud. Added three more stages to Freud’s stages to incorporate adult development offering a theory of development across the lifespan Interested more in the social-cultural aspect of personality as opposed to psychosexual. Believed that development is an evolutionary process based on sequencing; Biological, psychological and social/cultural events. Each stage signals a task that must be accomplished. Social/cultural expectations result in the individual developing a specific developmental task at each developmental stage. Erikson believed that the more success an individual has at each developmental stage, the healthier the personality of the individual. Developmental stages are viewed as a series of crises, successful resolution of these crises supports healthy ego development.  Failure to resolve crises damages the ego.	Kohlberg (Moral Development) Modified and expanded upon Piaget’s work to form a theory that explained the development of moral reasoning. Outlined six stages within three different levels. Proposed that moral development is a continual process that occurs throughout the lifespan. Level 1. Preconventional Morality Stage 1 - Obedience and Punishment The earliest stage of moral development is especially common in young children, but adults are also capable of expressing this type of reasoning. At this stage, children see rules as fixed and absolute. Obeying the rules is important because it is a means to avoid punishment. Stage 2 - Individualism and Exchange At this stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best-served Heinz’s needs. Reciprocity is possible at this point in moral development, but only if it serves one's own interests. Level 2. Conventional Morality Stage 3 - Interpersonal Relationships Often referred to as the "good boy-good girl" orientation, this stage of moral development is focused on living up to social expectations and roles. There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships. Stage 4 - Maintaining Social Order At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one’s duty and respecting authority Level 3. Postconventional Morality Stage 5 - Social Contract and Individual Rights At this stage, people begin to account for the differing values, opinions and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Stage 6 - Universal Principles Kolhberg’s final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.
Stage: Pre-schooler
Physical Changes Physiological changes, weight and height increases.  Large and fine muscle co-ordination improves.  By 5 years they can skip on alternate feet, use a skipping rope and begin to swim.  Intricate manipulations.		Theories: Information processing Attention: ability to pay attention and sustain it improves significantly during preschool years.  Memory: refers to the retention of information over time. Memory becomes more accurate, especially when given appropriate cues, prompts and rehearsal. Still has limitation and children may change their stories depending on how we ask questions.  Strategies: deliberate mental activities = rehearsing information (repeating) and organizing it are used by older children and adults. Still limited at this stage. During early childhood, preschooler’s thinking becomes more flexible, allowing more than one perspective.
Cognitive Changes 2-4 years.  Children judge persons, objects and events by their outward appearance or what seems to be.  Difficulty reasoning, thinking logically or comprehending that some things stay the same even if their appearance has changed e.g. fluid from a glass into a bowl.  The pre-schooler will assert that the glass contains more as it is at a higher level. 4 years - Children think in more complex ways – they are able to classify objects according to size or colour.  Egocentricity persists but slowly replaced with social interaction.  Children become aware of cause and effect relationships – the sun sets because people want to go to bed.  Causal thought also demonstrated through transductive thoughts e.g. the child in hospital.  I cried last night and that’s why the nurse gave me the injection.   At age 5 can use rules to understand causation.  Begin to reason from the general to the particular.  Basis if more formal logical thought ‘I get an injection twice a day; and that’s why I got one last night’.  Knowledge of the world remains closely linked to concrete experiences (perceived by the senses). Fantasy life is grounded in the perception of reality resulting in childhood fears.  Fear bodily harm, the dark, animals, thunderstorms and medical personnel.   Language:  5 years old more than 2000 words, can define familiar objects, identify colours and express desires as well as frustrations		Piaget 2-4 years - Preoperational stage of cognition.  First phase – preconceptual thought, characterised by perceptual-bound thinking 4 years – the intuitive phase of preoperational thought develops Egocentric: see only own point of view Morality: follow rules of those in authority
Psychosocial Changes Expands beyond the family into the neighbourhood.  Curiosity and developing initiative lead to exploration of the environment.  The development of new skills, new friends.  Lots of energy, plan activities beyond their capabilities, such as pouring milk from a two litre container into their cereal bowl.  Guilt when they overstep the mark.  Stress.  Play.		Erikson Initiative v guilt
Other Health Considerations Safety, MVA Less falls Poisonings Injuries Nutrition Immunisation Sleep Child abuse (maltreatment or neglect)		Kohlberg Preconventional Level A beginning understanding of behaviours considered socially right or wrong. Continues to be motivated by the wish to avoid punishment or the desire to obtain a reward.  The pre-schooler is better able to identify behaviours that gain rewards or punishment and begins to label these behaviours as right or wrong.
Learning capacity/teaching methods Learning Capacity of preschoolers: Vocabulary grows Uses language without comprehending the meaning of words, especially concepts such as time or right or left During play, child expresses feelings through actions rather than words Asks questions that imitate adults   Teaching methods: Use role-play, imitation and play to make it fun for preschoolers to learn Encourage questions and offer simple explanations and demonstrations Encourage children to learn together through pictures and short stories of how to perform hygiene Encourage questions and explain simply

Stage: Adolescents
Physical Changes Occur rapidly in adolescence. Sexual maturation.  Development of male/female sex characteristics.  Height and weight Pre-pubescent growth spurt usually occurs 2 years earlier in girls than boys	Theories
Cognitive Changes Multiple risk taking behaviours – smoking, drinking, STD’s, unintended pregnancy.  Solves problems through logical operations.  Moves beyond the physical or concrete properties of a situation and use reasoning powers to understand the abstract – what might be as opposed to what is. The personal fable – immune from negative consequences.  Can think but limited experience on which to build. Parents may be considered narrow minded or too materialistic. Language development fairly complete.  Develop different skills and styles of communication and learn how and when to use them most effectively.	Piaget Formal operations – highest level of intellectual development
Psychosocial Changes Search for personal identity.  Must establish close peer relationships or remain socially isolated.  They become emotionally independent from their parents, while retaining family ties.  They need to develop their own ethical system based on personal values.  Career choices.  Components of total identity evolve from these tasks.  Behaviours indicating negative resolution of the developmental task for this age are indecisiveness and the inability to make an occupational choice.    Develop intimate relationships with partners.  Sexual identity. Group identity – leads to esteem and acceptance – dress.  Popularity is a major concern – sense of belonging and approval. Family identity – move away from family to peers, budget for clothing.  Need firm, supportive family foundation. Vocational identity Moral identity – depends heavily on cognitive ability	Erikson Identity v role confusion Sees identity (or role) confusion as the prime danger of this stage and suggests that the cliquishness and intolerance of differences seen in adolescent behaviour are defences against identity confusion. Psychosocial moratorium – time out period when society allows the physically mature teenager to delay the assumption of adult responsibilities
Other Health Considerations Health identity Health promotion Accidents Suicide  Substance abuse Eating disorders Sexual experimentation Sexually transmitted diseases Pregnancy	Kohlberg Adolescents judge themselves by internalised ideals, which often lead to conflict between personal and group values.  Group values become less significant in later adolescence.  Justice based on reciprocity and equal respect. Ages at which adolescents may pass through levels/stages 12- 14 years - Level 2 (conventional level).  Stage 3 (good boy-nice girl orientation) 14-16 years - Level 2 (conventional level).  Stage 4 (society maintaining orientation) 17-21 years – Level 3 (post conventional level).  Stage 5 (social contract orientation) and Stage 6 (universal ethical principle orientation).
Learning capacity/teaching methods Leaning Capacity of Adolescents 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 Help learn about feelings and need for self expression Allow to make decisions about health and promotion Use problem solving to help make choices

Stage: Young Adulthood
Physical Changes Completed physical growth by 20 years old.  Pregnancy. Personal lifestyle assessment.	Theories
Cognitive Changes Rational thinking habits increase steadily through the young and middle adult years.  Prefrontal cortex of the brain is fully developed – governs the persons ability to reason in a mature way and to control reckless impulses. Adult learning principles	Piaget acknowledged the possibility that important advances in thinking follow the attainment of formal operations during adolescence. Young adults are more quantitative advanced because they have more knowledge than adolescents Kohlberg: Maybe at any of these stages 12- 14 years - Level 2 (conventional level).  Stage 3 (good boy-nice girl orientation) 14-16 years - Level 2 (conventional level).  Stage 4 (society maintaining orientation) 17-21 years – Level 3 (post conventional level).  Stage 5 (social contract orientation) and Stage 6 (universal ethical principle orientation).
Psychosocial Changes The emotional health of the young adult is related to the individuals ability to resolve personal and social tasks. 23-28 years – refines self-perception and ability for intimacy 29-34 years – directs energy towards achievement and mastery of the surrounding world. 35-43 years – vigorous examination of life goals and relationships.  May result in midlife crisis. During young adult years – occupational and social pursuits.  Attempt to improve their socioeconomic status.  Upwardly mobile. Two incomes. Ethnic and gender factors – role expectations Women continue to work during child-rearing years – many women struggle – stressors. Career, marriage and parenthood.  Lifestyle, sexuality and relationships – single state, partners and marriage Parenthood. Hallmarks of emotional health	Erikson Intimacy v isolation
Other Health Considerations Health risks  - family history, personal hygiene habits, violent death and injury, substance abuse, unplanned pregnancy, SDT’s environmental or occupational factors. Health concerns – health promotion – SDT’s, infertility, exercise, routine health screening,  Psychosocial health – job stress, family stress Childbearing cycle – health practices, prenatal care, first trimester, second trimester, third trimester, puerperium, sensory perception, education, psychosocial concerns.  Acute care Restorative and continuing care	Additional Information
Learning capacity/teaching methods Complies with health teaching because client fears results – encourage participation by setting mutual goals Learning occurs when adult values information being taught – encourage independent learning  Offer information so that the adult can understand effects of health promotion Learning Capacity for young and middle adults: Complies with health teaching because client fears the results Learning occurs when adult values information being taught Teaching methods: Encourage participation by setting mutual goals Encourage independent learning Offer information so that adult can understand effects of health problem