Theories of Development in Nursing-Part 1

Lecture No.2
Learning Objectives

• Key theories that explain how children grow, develop, and learn throughout
their lives
• Applying developmental theories in care plans
• Overview of Sigmund Freud’s Psychosexual theory
• What are the strengths and weaknesses of the theory?
• How does Erikson’s psychoanalytic theory compare to Freud’s theory?
• What crisis characterizes each of Erikson’s psychosocial stages?
Theories of Human Development

• Theory: Ideas proposed to describe/explain certain phenomena & predict

behavior

• Why are theories important?

 To give meaning to what we observe.

 Finding ways to improve the lives and education of children.

Theoretical Models of Development

 Fraud’s Psychosexual theory.

 Erikson’s Psychosocial theory.

 Piaget’s Theory of Cognitive Developmental.

 Kohlberg’s Theory of Moral Development .

Sigmund Freud’s Psychosexual Theory
 Was based on his therapy with troubled adults.

 Beliefs focus on the formation of personality. According

to this approach, children move through various stages,
confronting conflicts between biological drives and social
expectations.

 He emphasized that a child's personality is formed by the

ways which his parents managed his sexual and
aggressive drives.

 Psychoanalysis made him believe that early childhood

experiences form the unconscious motivations for actions
in later life.
Personality Development

According to Freud, personality develops in stages; everyone goes through

same stages in same order. Majority of personality is formed before age 6

From observations, Freud found that child development occur over series of
psychosexual stages in which the child’s sexual gratification become focused
on particular body part.

Erogenous Zone: Area on body capable of producing pleasure

Fixation: Unresolved conflict or emotional hang-up caused by frustration
Sigmund Freud’s Psychosexual Development

Conscious mind: the part of which we are aware

Level of conscious

Unconscious mind: the part of which we are not aware

Id, ego and

Components of the personality superego

Theory of psychosexual development 5 stage

 Personality Structure Model
ID SUPEREGO

EGO
The unconscious Ego is always caught in the
is further divided middle of battles between
into 3 parts superego’s desires for moral
behavior and the id’s desires for
immediate gratification.
 Unconscious CONFLICT can be RESOLVED BY
DREAMS
NEUROTIC SYMPTOMS
DEFENCE MECHANISMS: a process used by the ego to protect ourselves from feelings of
anxiety or guilt
 Examples of Defenses Mechanisms
Identification A focus on negative or feared traits If you are afraid of someone, you can practically conquer that fear by
becoming more like them

Repression An unconscious mechanism employed by ego to keep During the Oedipus complex aggressive thought about the same sex
(forgetting) ‫قمع او كبت‬ threatening thoughts from becoming conscious. parents are repressed

Denial blocking external events from awareness, the person just Smokers may refuse to admit to themselves that smoking is bad for their
l (ignoring) ‫انكار‬
refuses to experience it. health.

Projection This involves individuals attributing their own You might hate someone, but your superego tells you that such hatred is
l(attributing to others)
unacceptable thought, feeling and motives to another unacceptable. You can solve the problem by believing that they hate you.
person.
‫اسقاط‬
Displacement Satisfying an impulse with a substitute object.
l Someone who is frustrated by his or her boss at work may go home and
kick the dog.

Regression This is movement back in psychological time when one is A child begin to suck their thumb again or wet the bed when they need to
l (retreating to an faced with stress spend some time in the hospital.
earlier stage)
Sublimation Satisfying an impulse (e.g. aggression) with a substitute Sport is an example of putting our emotions (e.g. aggression) into
l (channeling into
object. In a socially acceptable way. something constructive.
acceptable outlets)
Rationalization the cognitive distortion of “the facts” to make an event or A boy neglected by his girlfriend says she was not that attractive anyway.
l (making excuses) an impulse less threatening

Reaction formation A person goes beyond denial and behaves in the Conscious feelings are the opposite of the unconscious. Love –hate,
l (converting to its
opposite way to which he thinks or feels Shame- disgust and moralizing are reaction formation against sexuality
opposite)
Freudian Stages
Each stage
6 yrs to produces
Birth to 1 to 3 3 to 6 puberty Puberty
1 yrs yrs years (12) onward 12+ frustration,
Infant Toddler Preschool School Adolescent conflict, and
Oral Stage Anal Stage Latency anxiety. If not
Phallic Genital
Stage Stage Stage resolved
Infant’s Child’s properly,
pleasure pleasure Child
centers on focuses Child’s A time of normal
on pleasure represses sexual
Mouth anus sexual
focuses on reawakening; development
genitals interest source of
and develops sexual
may be
social and pleasure interrupted, and
intellectual becomes
skills someone
a child may
Id outside of the remain fixated,
Ego Super Ego family or stuck, at a
current stage.
Freud: Personality is formed within the first 6 yrs
 Oral Stage (Ages 0-1)-Infancy
 Babies experience world through their mouth (sucking, chewing, biting). If a child is overfed or
frustrated, oral fixation will develop. Early oral fixations can cause…
 Oral Dependent Personality: Gullible, passive, and need lots of attention
 Later oral fixations can cause…
 Oral-aggressive adults who like to argue and exploit others; smoking & over eating; nail biting
& chewing on pencils as adults
 Primary need: Security;
 Major conflict: weaning
Nursing Implications
 Provide oral stimulation by giving pacifiers.
 Do not discourage thumb sucking.
 Breast feeding may provide more stimulation than formula feeding because it requires the
infant to expend more energy.
Anal Stage (Ages 1-3): Toddler

 Attention turns to process of elimination. Anus is the pleasure zone;

Toddlers experience conflict over toilet training
– Anal Retentive: Holding everything in, Obsessive about neatness
and cleanliness
– Anal expulsive : Messy & disorganized

 Major conflict: toilet training

Nursing Implication
 Help children achieve bowel and bladder control without undue
emphasis on its importance.
 If at all possible, continue bowel and bladder training while child is
hospitalized.
Phallic Stage (Ages 3-6) Preschool
 Child starts to develop a strong desire to know his own sex identity as well as the other sex
identity (site of gratification: Genitals)
 Child now notices and is physically attracted to opposite sex parent. Can lead to:
 Major conflict: Oedipal & Electra Complex
Oedipus Conflict: For boys only. Boy feels rivalry with his father for his mother’s affection. To
resolve, boy must identify with his father (i.e., become more like him and adopt his
heterosexual beliefs).
Electra Conflict: Girl loves her father and competes with her mother. Girl identifies with her
mother more slowly.
Nursing Implication
 Accept child's sexual interest as a normal area of exploration.
 Help parents answer child's questions about birth or sexual differences.
 The nurse must provide privacy and clear explanations during any procedures involving the
genital area.
Latency Stage (Ages 6-12) School Age

 A period of on hold sexual activity, energies shift to physical & intellectual

activities (Site of gratification: school activities)
 Same sex friendships and play occur here
 Child avoids members of the other gender
 Major conflict: School activities

Nursing Implications
Provide gowns, covers, & underwares at hospital; knock the door before entering.
Genital Stage (Puberty-12+) Adolescent

Pleasure zone: genitals

Adolescent adult has mature sexual feelings and experiences pleasure from
sexual relationships with others.
Tasks to achieve: good relationships with members of both sexes
Major conflict: Sexual intimacy

Nursing Implications

 Provide appropriate opportunities for the individual to relate with opposite sex
 Allow individual to verbalize feelings about new relationships.
Evaluation of Freud’s Theory
– Freud overemphasized sexuality and placed little emphasis on other aspects
of the child’s experience.
– Freud’s theory is largely untestable. Particularly, the concept of the
unconscious is unprovable.
– According to Freud, the only way that people in psychological distress can
get relief is to identify unresolved conflicts from infancy and childhood.
Strengths
Awareness of unconscious motivation
Emphasized important early experience
Weaknesses
Ambiguous, inconsistent, not testable
Not supported by research
Psychosocial Theory: Erik Erikson

• Personality development is a psychosocial process

• A lifelong experience and are influences by three
interrelated forces
- Biological and physical strengths and weaknesses
- Experiences
- Social
• Comparing Erickson with Freud
• Children are active explorers, not passive slaves to
biological urges
• Emphasis on social influences, less on sexual urges
Erikson identifies a crisis, that is, a particular challenge that exist for healthy
personality development to occur.

Crisis refer to a normal maturation social needs rather than to a single critical
event.

Each developmental crisis has two possible outcomes; when needs are meet,
the consequence is healthy & the individual move on to future stages with
particular strength.

When needs are not met, an unhealthy outcome occurs that will influence future
social relationships.
Eight Life Crises ( Psychosocial Stages)

Ages 65+: old adulthood Integrity vs. Despair

Ages 30 – 65:Middle adulthood Generativity vs. Stagnation

Ages 20 – 30: Young adulthood

Intimacy vs. Isolation

 Ages 12 – 20: Adolescence Identity vs. Role confusion

Ages 6 – 12: school age

Industry vs. Inferiority
Ages 3 – 6: Preschool
Initiative vs. Guilt

Ages 1 – 3: Toddler
Autonomy vs. Shame/Doubt

Trust vs. Mistrust Ages Birth – 1: Infancy

 Stage 1 - Trust vs. Mistrust (Birth-1 yrs) Infancy
 Parallel to freud’s oral stage
 Because an infant is utterly dependent, the development of trust is based on the
quality of the child’s caregivers.
 Erikson believed that this period is key for the development of attachment: a close
emotional bond between infant and caregiver.
 If a child successfully develops trust, he or she will feel safe and secure in the
world. Caregivers who are inconsistent, emotionally unavailable, or rejecting
contribute to feelings of mistrust in the children they care for. Children become
fearful & suspicious.

Nursing Implications:
 Provide a primary caregiver.
 Provide experiences that add to security, such as soft sounds and touch.
 Provide visual stimulation for active child involvement
 Encourage parental bonding & address attachment issues.
Stage 2 - Autonomy vs. Shame and Doubt (1-3 yrs): Toddler

 Like Freud, Erikson believed that toilet training was a vital part of this process.
However, Erikson's reasoning was quite different than that of Freud's. Erikson
believe that learning to control one’s body functions leads to a feeling of control
and a sense of independence.
 Other important events include gaining more control over food choices, toy
preferences, and clothing selection.
• Children are discovering their own independence (doing things for themselves);
Those who given the opportunity will gain a sense of autonomy, while those
who overly restrained (protective) or punished will develop shame and doubt

Nursing Implications:
 Provide opportunities for decision making, such as offering choices of clothes
to wear or toys to play with.
Stage 3 - Initiative vs. Guilt (3-6 yrs) Preschool

 Based on newly acquired skills and their own initiative children begin to explore and move
out into a wider social world. Helps them to learn responsibility for their bodies, behaviors,
toys, and social roles.

 The child also begins to gain a sense of what is right and wrong based on their
experiences.

 Initiative: Parents reinforce & reward via giving children freedom to play, use imagination,
and ask questions

 Guilt: May occur if parents criticize, punishment & lowered self-esteem, prevent play, or
discourage a child’s questions

Nursing Implications:
 Provide opportunities for exploring new places or activities. Allow play to include activities
Stage 4 - Industry vs. Inferiority (6-adol) School

 Child is in school and the focus has shifted from parents to teacher.
 A child who engages in behaviors that lead to school success, such as
figuring out how things work or how they are made, has a sense of
competence or industry.
 If a child’s industry is met with disapproval from teachers or parents, leads to
a sense of inferiority.
 So, the child will either become competent and effective at activities valued
by adults and peers or they will feel inferior.

Nursing Implications:
 Provide opportunities such as allowing child to assemble and complete a
short project so that child feels rewarded for accomplishment.
Stage 5 - Identity vs. Confusion (Adolescent)

• Developing a sense of self and where one is going in life

• Identity: For adolescents; problems answering, “Who am I?”
• Role Confusion: Occurs when adolescents are unsure of where they
are going and who they are

Nursing Implications:
 Provide a safe space for self-exploration & discussion of identity
 Address concerns about peer pressure & body image
Stage 6 - Intimacy vs. Isolation-Early Adulthood)

 Time for sharing oneself with another person

 Erikson believed it was vital that people develop close, committed

relationships with other people. Those who are successful at this step will
develop relationships that are committed and secure.

 Remember that each step builds on skills learned in previous steps. Erikson
believed that a strong sense of personal identity was important to
developing intimate relationships. Studies have demonstrated that those
with a poor sense of self tend to have less committed relationships and are
more likely to suffer emotional isolation, loneliness, and depression.
Stage 7-Generativity vs. Stagnation: Middle Adulthood

 During adulthood, we continue to build our lives, focusing on our career and
family.

 Adults must be productive in their work and willing to raise the next
generation, or they risk stagnation.

 Generativity encompasses the idea of feeling needed, influence your env’t.

 Each adult must find some way to satisfy and support the next generation.

 Stagnation: When one is only concerned with one’s own needs and
comforts
Stage 8 - Integrity vs. Despair: Late Adulthood

 People try to make sense of their prior experience ( reflecting back on life)

 Those who are unsuccessful during this phase will feel that their life has been
wasted and will experience many regrets. The individual will be left with
feelings of despair.

 Those who feel proud of their accomplishments will feel a sense of integrity.
Successfully completing this phase means looking back with few regrets and
a general feeling of satisfaction. These individuals will attain wisdom, even
when confronting death

Nursing Implications:
 Facilitate life review & discussions about accomplishments.
 Provide emotional support & address end-of-life concerns.
In Summary
• Strengths
– Emphasis on interaction of biological and social influences
– Influenced research into adolescence and adulthood

• Weaknesses
– Sometimes vague and difficult to test
– Describes human personality development but does not explain how
development occurs