Trust vs Mistrust: sense of trust in others and oneself is an essential part of human development and for the formation of health identity.

• Infants and caregivers interaction need to meet the infant's basic needs of caring and comfort.

• Caregivers need to provide consistency in food, comfort and affection for the infant to learn to trust.

Piaget:

Developmental characteristics, Sensorimotor:

• With increased mobility and awareness the infant will explore the world through sensory and motor contact.

• During the infant stage object permanence and separation anxiety emerge.

• Goal directed behaviors begin

Kohlberg:

Did not find information for infants for this theory of moral developement.

Infancy: Trust vs Mistrust

• Infants rely on basic needs from caregivers

• Trust develops when caregivers provide warmth, security, comfort, and food

• Mistrust results in feelings of withdrawal and suspicion

Piaget

Infancy: Sensorimotor Stage

• Human and cognitive development occur within the first 2 years

• Sucking, grasping, looking, and listening occurs

• Physical mobility increases with crawling and sitting up

Kohlberg

Infancy: Obedience vs Punishment

• Young children follow rules to avoid punishment

• Not a lot of information on infancy in Kohlberg's theory

-Gracie

During this stage, toddlers are developing a great sense of self-control, figuring out if they can do things on their own, or if they require assistance. An example of this would be using the bathroom by themself.

Piaget: The Preoperational Stage of Cognitive Development

Toddlers are beginning to think symbolically, and utilizing words and pictures to represent objects. While they are getting better with language and thinking, they still think in very concrete terms

Kohlberg: Preconventional Moral Stage

Toddlers are determining what is right and wrong, defining what is wrong by what they get punished for.

(sam)

-Ashley

Erikson: Initiative vs. Guilt

• Preschoolers continue to explore their environment and try out different roles --> initiative adds to autonomy as children learn basic skills to master the world around them

• When parents, caregivers, and other support systems of the child encourage the quest for independence, the child develops a sense of direction and purpose. Without this freedom and guidance, children may develop feelings of guilt and inadequacy

Piaget: Preoperational stage 2-6 years

• Children use their imagination symbolically to engage in play, fantasy, and make believe. Children learn through play at this age

• This stage is characterized by egocentrism where children see themselves as the center of the universe and are unable to accept or understand other points of view

Kohlberg: Preconventional Stage 4-10 years

• Moral development based on external forces - controlled almost exclusively by rewards and punishments

• Instrumental relativism - children start to learn personal gain and that there are benefits to pleasing others

-Shaylyn

-Ashley

Children at this age understand ideas such that if nothing is added or taken away then the amount stays the same even if the appearance changes.

Logical thinking begins in this stage.

-Ashley

Freud: Latent Stage - Children hold in sexual urges from Stage 3 and turn it into socially acceptable activities; much to learn and accomplish.

Erikson: Industry vs. Inferiority - learning socially productive skills and tools; learn to interact with peers; thrive on accomplishments and praise; create a routine and allow them to participate in treatment

• Jordan

• patient's moral values and principles come into prominence.

• social contract orientation: patient in this stage thinks about what society should value!

• Universal Ethical Principle Orientation: patient thinks about what is just, even if the law does not support it.

• Nursing considerations: respect patient's moral values and principles when delivering care. Incorporate their values into their care plan!

According to Piaget's cognitive development theory, adolescents are in the formal operations period and abstract thinking.

• egocentric thought

  • Imaginary audience constantly judging appearance and actions.

  • Personal fable: thoughts and feelings are unique.

  • invulnerability.... risk-taking behaviors!

• Able to reason with different possibilities.

• Nursing considerations: remind patient that they are not so different than everyone else in that others may share the same thoughts and feelings as them.

  
  

According to Erickson's psychosocial theory, adolescents are in the identity vs. role confusion.

• Who am I?

• Mastery of this stage results in respect to others and to their own ideals. This person is integrating into society as an interdependent member.

• Nursing considerations: respect the adolescent's independence and offer them the necessary information to help them make decisions on their treatment plan.

  
  

  • Tori Krcmarik

  
  

  
  

  
  

• close personal relationships, meaningful = intimacy

• superficial and unfulfilled relationships = isolation

• Explore places to meet others who share their interests and find others they feel a strong connection with

• Loneliness may occur from losing friendships, relationships, or a new situation that changes their social circles

• May begin to push away from others if they feel discouraged from a lack of social interactions

Piaget: Formal operational

• Able to think abstractly and hypothetically, considered the highest level of cognitive development

• Problem solving is improved

• Finding people to share experiences, and who have similar thoughts, and emotions with

• This is difficult because the formal operational stage begins at age 12 and there are significant cognitive changes between this age and young adulthood

Kohlberg: Post-conventional reasoning

• Social contract, and universal ethical reasoning

• It is believed that most individuals do not reach universal ethical reasoning

• Often act and make decisions that they approve of and believe are right, rather than society's expectations

• Looking at ways laws and rights can change to become increasingly beneficial for society

• This is also difficult because this stage spans from adolescence to older adults

- Elise

• undertake activity that benefits others (family, mentoring, coaching) = generativity

• unconcerned about the welfare of others, feeling unproductive, uninvolved in the world, dissatisfied = stagnation

At this developmental stage, individuals want to inspire and teach future generations. Alongside this they want to find a sense of fulfillment within themselves. They turn towards parenthood and volunteering in their local communities. Being a parent, one can easily get caught up in this stage and forget that they need to do things themselves. That is why it is important to do things for oneself to avoid developing unhealthy patterns that could extend into the next developmental stage.

Piagets theory: Formal operations She says that in this stage middle adults have developed more ways of thinking instead of being concrete. The possibilities one can think of could be endless. I think this is important because this stage on top of there being many lifestyle changes, jobs can change too and these individuals in this stage should know that this is normal instead of feeling alone. Nursing consideration for this should include assessing the cognitive capacity of the individuals you are caring for when providing health care teaching.

Kohlbergs theory: Stage 6: Universal Ethical Principle Orientation By this middle stage individuals should know what they believe in and that it sometimes requires standing up for yourself.

Integrity vs. Despair:

• Individuals contemplate and reflect upon their life by looking at their accomplishments and failures.

• Integrity is achieved if individuals accept their life choices and have little desire to redo their life

• Can occur earlier in life if person feels they are near the end of life.

• Those that feel regret and dissatisfaction with life may experience feelings of despair and hopelessness and feel as though their life has been wasted.

Nursing Considerations:

• Encourage self sufficiency to promote feelings of independence but assist when necessary.

• Provide socialization opportunities and daily social interaction to prevent social isolation

• Encourage patients to reminiscence about previous positive life events and relationships.

Kohlberg- Moral Development

Postconventional Reasoning

• Individuals who operate at this level of thinking usually act according to their own principles and beliefs rather than relying on external forces to shape actions.

• Guided by a set of principles such as social justice, liberty, and human dignity

• They perceive rules as malleable and subject to change

Social Contract (Stage 5)

• Rules challenged if they impinge on the rights of others

• Promote the common good

Universal ethical principles (Stage 6)

• Individuals formulate and apply their own rules based on ethical principles

• Justice, compassion, and equality for the basis of a personal code that may conflict with society's expectations and laws

Nursing Considerations:

• Prioritize autonomy allowing them to make their own health care decisions and provide thorough education as necessary.

  
  

  **Paiton Kujawa

  
  

Piaget’s theory states that adults have achieved the formal operational stage and can apply abstract logic. Adults are able to use hypothetico-deductive reasoning and form a hypothesis. Nurses can educate older adults about their health and allow them to use their advanced reasoning to make informed decisions to improve their quality of life.

Postconventional reasoning can occur in older adults. Kohlberg’s theory states that at this level of reasoning people follow universal ethical principles and don’t just blindly obey laws. Older adults have had a long time to develop their own personal values. Nurses can recognize the moral principles that patients have and respect a patient’s wishes when it comes to code status and treatment options.  

Harleen Arora

1. Monitor for changes in mobility, gait and coordination. Provide assistance with walking, help ambulate with assistive devices.

2. Monitor for changes in cognition and implement safety measures such as fall risk precautions, neurological assessments, rearrangement of patient room to ensure safety. Understand the implications of Piagets formal operational stage: For older adults you may begin to see declines in areas of deductive reasoning. An example of reduced deductive reasoning in older adults may include medication reconciliation errors, dosing errors, pill counting errors, etc. Nurse should provide patient education on medication administration to patients family to ensure patient safety. Nurse should know that patients overall reasoning may be impaired during late adulthood.

3. Not confuse depression with dementia. Older individuals will often deny depression. Some indicators of depression in older adults include negative outlook on life, feelings of guilt, and suicidal ideation. Nurse should remember Erikson's stage of ego vs despair when interacting with patient. Identify if patient shows sign of regret, guilt and be mindful not to exacerbate these feelings with judgmental or shameful comments.

4. Encourage patient exercise. Encourage ROM activities to reduce contraction of extremities and to promote overall health. Promote patient autonomy (e.g. if patient can dress themselves, allow them to do so). Respecting the autonomy of others exemplifies Kohlbergs moral development stage of universal/ethical principle.

5. Encourage social interaction and cognitive stimulation (e.g. bingo night with friends, crossword puzzles).

-Milsap

1.      Monitor for changes in mobility, gait and coordination. Provide assistance with walking, help ambulate with assistive devices.

2.      Monitor for changes in cognition and implement safety measures such as fall risk precautions, neurological assessments, rearrangement of patient room to ensure safety. Understand the implications of Piagets formal operational stage: For older adults you may begin to see declines in areas of deductive reasoning. An example of reduced deductive reasoning in older adults may include medication reconciliation errors, dosing errors, pill counting errors, etc. Nurse should provide patient education on medication administration to patient’s family to ensure patient safety. Nurse should know that patients overall reasoning may be impaired during late adulthood.

3.      Not confuse depression with dementia. Older individuals will often deny depression. Some indicators of depression in older adults include negative outlook on life, feelings of guilt, and suicidal ideation. Nurse should remember Erikson's stage of ego vs despair when interacting with patient. Identify if patient shows sign of regret, guilt and be mindful not to exacerbate these feelings with judgmental or shameful comments.

4.      Encourage patient exercise. Encourage ROM activities to reduce contraction of extremities and to promote overall health. Promote patient autonomy (e.g. if patient can dress themselves, allow them to do so). Respecting the autonomy of others exemplifies Kohlberg’s moral development stage of universal/ethical principle.

5.      Encourage social interaction and cognitive stimulation (e.g. bingo night with friends, crossword puzzles).

-Milsap

-Ashley

-Emily

Promoting Health in the Group

Immunizations-Influenza, HPV, and Meningococcal

Nutrition-Focus on body image can change eating behaviors and put patients at risk for Anorexia and Bulimia

Injury Prevention-Depression Screening (This group can experience bullying, relationship conflict, and mood changes.), Motor Vehicle Safety (When these patient's start driving, safety is of upmost importance. Providers can teach on danger of texting while driving, substance use, and seat belt safety.)

Erikison's Stage (Identity vs. Role Confusion)

-Discovering Identity

-Focusing on Appearance

-Peer Influences

-Risk-Taking Behavior (Prefrontal Cortex not developed)

-Success in this stage= finding purpose

Piaget (Formal Operational)

-Shift in thinking from concrete to more abstract reasoning

-Self consciousness sets in

Kohlbergs Theory (Postconventional Reasoning)

-Social contract

-Universal ethical principals

-Will establish reliance on own principles rather than seeking out outside opinions