Growth & Development

PRINCIPLES OF DEVELOPMENTContinuous process through lifeOrderly sequencePredictable but unique rangesSystems mature at different ratesMore rapid in early periodsPace/PatternGross to refined skills simple to complex

Proximal to Distal/Simple to Complex

Nature vs NurtureGenetics vs Environment

Humans grow and develop in the following dimensionsPhysicalCognitivePsychosocialMoralSpiritual

Freud Psychosexual developmentBased on sexual motivation

LIBIDO energy or life instinct

PSYCHOSEXUAL THEORY Freud (1923)Oral-sensory infancy

Anal muscular toddlerhood

Phallic locomotion pre-school

Latency school age

Genital puberty to adulthood

Erikson's Stages of Psychosocial DevelopmentStage I: Trust vs. mistrust (Infancy)Stage II: Autonomy vs. shame and doubt (Toddler)Stage III: Initiative vs. guilt (Preschool years)Stage IV: Industry vs. inferiority (School age years)

Eriksons Stages (Cont..)Stage V: Identity vs. role confusion AdolescenceStage VI: Intimacy vs. isolation Young AdulthoodStage VII: Generativity vs. stagnation Middle AdulthoodStage VIII: Ego Integrity vs. despair Later Adulthood

Cognitive Development TheoryPiaget (1969)Cognitive development: * Brain * Nervous system * ExperiencesAdaptation - adjustAssimilation - integrationAccommodation process new information

COGNITIVE DEVELOPMENTAL THEORY Piagets stages of development: 1. Sensory Motor - birth to 2 years Reflex activities Exploration

Piaget Stages of Development 2. Pre operational 2-7 years

Pre-conceptual, Intuitive figures things out

Piaget Stages of Development 3. Concrete Operations 7-11 years compliance

Piaget Stages of Development 4. Formal Operations 11- adult

Kohlberg - Moral Development Pre conventional birth to age 9Punishment/obedienceorientation

Kohlberg cont.Conventional morality 9-13 years

Post conventional level of morality 13 years to death: * Contractual/legalistic * Universal ethical

Maslows Theory of Human Needs (1950)PhysiologicalSafetyBelonging/loveEsteemSelf actualization

Self ConceptAn individuals conceptualization of himself or herselfSubjective sense of selfComplex mixture of conscious and unconscious thoughts, attitudes and perceptionAffects ones self esteem and how one feels about himself or herself

Stressors Influencing Self Concept

Self Concept and the Nursing ProcessAssessmentNursing DiagnosisPlanning: Goals and OutcomesImplementationEvaluation

Myths and StereotypesIll, disabled, physically unattractive

Financial Status affluent to poor

Undervaluing by society due to attractiveness, energy & youth

Outdated knowledge and experience

Developmental Tasks For Older AdultsAdjustment to:Decreasing health and physical strengthRetirement and reduced or fixed incomeDeath of a spouse, children, siblings & friendsAccepting self as aging personMaintaining satisfactory living arrangementsRedefining relationships with adult children and siblings Finding ways to maintain quality of life

Focus on Older Adults

Health Care SettingsHospital

Nursing Home

Ambulatory Care

Home Care

Physiological Changes with AgingIntegumentaryRespiratoryCardiovascularGastrointestinalMusculoskeletalNeurologicalSensory eyes, ears, taste, smell, touch, proprioceptionGenitourinaryReproductiveEndocrineImmune

Other Changes Associated with AgingFunctional ChangesCapacity & safe performance of ADLsCognitive ChangesDelirium, dementia & depressionPsychosocial ChangesInvolves life transitions and loss (Retirement, social isolation, sexuality, housing and environment and death)

Health Promotion & MaintenanceParticipation in screening activitiesRegular exerciseWeight reductionWell balanced dietModerate alcohol useSmoking cessationRegular dental visitAnnual Immunization

Risk Factors for Falls in the Older AdultIntrinsic FactorsHistory of fallsImpaired visionConditions affecting mobilityCognitive impairmentAlteration in bladder functionMedicationSlow reaction time

Extrinsic FactorsEnvironmental hazardsInappropriate footwearUnfamiliar environmentImproper use of assistive devices

Older Adults in Acute Care SettingsPoses increased risk for adverse events such as:DeliriumDehydrationMalnutritionHealth care associated infectionUrinary IncontinenceFalls

Older Adults and Restorative CareRefers to two types of care: the continuation of recovery from acute illness or surgery that begins in the acute care settingSupport of chronic conditions that affect day-to-day function

Both types of care take place in private homes and long-term care setting