PLT College Inc

Institute of Health Sciences- College of Midwifery

Human Growth and Development

(Prepared By: Prince Rener V. Pera, RN, MSN,EMT)

 Growth – physical change and increase in size

 Measured quantitatively
- Height, weight, bone size, dentition and sexual characteristics.
 Growth rate:
- Rapid: prenatal, neonatal, infancy and adolescent stages
- Slows down: childhood, minimal physical growth during adulthood
 Development – refers to changes in skill and capacity to function.
 Qualitative in nature and difficult to measure
 Behavioral aspect of growth:
E.g. Ability to walk, talk, runs
 Simple to complex, general to specific, head to toe and from trunk to the extremities.
 Maturation- is the process of aging; ability to adapt and show competence in new
situations.
 Differentiation – process by which the cell and structures become modified and develop
more refine characteristics

I. PRINCIPLES:
1. Growth and development are continues, orderly, sequential processes influenced by
maturational, environmental and genetic factors.
2. All humans follow the same pattern of growth and development.
3. The sequence of each stage is predictable. Although time ,of onset, the length of stage, and
the effects of each vary with the person.
4. Learning can either help or hinder the maturational process, depending on what is learned.
5. Each developmental stage has its own characteristics.
6. Occurs in cephalocaudal direction.
7. Occurs in proximal to distal direction.
8. Development proceeds from simple to complex or from single acts to integral acts.
9. Development becomes increasingly differentiated.
10. Certain stages of growth and development are more critical than others.
11. The pace of growth and development is uneven.

FACTORS INFLUENCING GROWTH AND DEVELOPMENT

1. Heredity 6. Health environment 11. Living

2. Temperament 7. Prenatal health 12. Environment
3. Family 8. Nutrition
4. Peer group 9. Rest, sleep and exercise
 5. Life experiences 10. State of health
Theories on Human Growth and Development

PSYCHOSEXUAL DEVELOPMENT
A. Freud, Sigmund

Personality- outward expression of inner self.

- encompasses temperament, feeling, characteristics, traits, independence, self esteem,
self-concept, ability to interact with others, behavior and ability to adapt to life
changes.

ID- source of instinctive and unconscious urges.

- Chiefly sexual in nature.
- Pleasure Principle
EGO- is the conscious self, the “I” that deals with personality.
- The part of the personality that is shown to the environment.
- Reality Principle
SUPEREGO/ EGO IDEAL- conscience of the personality
- Source of feeling of guilt, shame and inhibition.
LIBIDO- energy form or life instinct that motivates human development.
FIXATION- immobilization or inability of the personality, to proceed to the next stage
because of anxiety.

5 Stages of Development

STAGE AGE CHARACTERISTICS IMPLICATIONS

1. ORAL Birth to -mouth is the center of pleasure - Feeling produces
1 year -begins to develop self-concept from the pleasure and sense of
responses of others comfort and safety.
-feelings of dependence arise and persist Feeding should be
thru life pleasurable and provided
Fixation: Individual may have difficulty when required.
trusting others, may demonstrate nail
biting, drug abuse, smoking, overeating,
alcoholism, argumentativeness and
overdependence

2. ANAL 2 and 3 -anus and rectum are the centers of
yrs pleasure
- occurs during toilet training
-Struggle of giving self and breaking the
symbiotic ties to mother; as the ties are
broken, the child learns independence.
Fixation: Obsessive- compulsive
- Controlling and
expelling feces provide
pleasure and sense of
control. Toilet training
should be a pleasurable
experience and
appropriate praise can
 personality traits such as obstinacy, result in personality that
stinginess, cruelty and temper tantrums. is creative and
productive.
3. PHALLI 4 and 5 - child’s genitals are the center of - The child identifies with
C/ yrs pleasure the parent of the
OEDIPAL -Sexual and aggressive feelings opposite sex and later
associated with genitals come into focus. takes on a love
- Masturbation offers pleasure and the relationship outside the
child experience the family. Encourage
identify.
OEDIPUS COMPLEX- refers to his mother
and hostile attitudes towards his father.
ELECTRA COMPLEX- refers to the female
child’s attraction for his father and
hostile attitudes toward his mother.
Fixation: If unresolved can result in
difficulties with sexual identify and
problems with authority
4. LATENC 6 to 12 -energy is directed to physical and Encourage child with
Y yrs intellectual activities physical and intellectual
-sexual impulses tend to be repressed pursuits
-Fixation: May result in obsessiveness
and lack of self motivation if unresolved
conflicts
5. GENITA 13 yrs -energy is directed toward attaining a Encourage separation
L and mature sexual relationship. from parents,
after -Fixation: Sexual problem such as achievement of
frigidity, impotence, and inability to have independence and
a satisfactory sexual relationship. decision making

PSYCHOSOCIAL DEVELOPMENT THEORY

B. Erikson, Erik H.

Ego is the conscious core of personality.

Development through entire life span.
The greater the task achievement, the healthier the personality of the person.
Failure to resolve the crises is damaging to the ego

STAGE AGE TASK POSITIVE RESOLUTION NEGATIVE RESOLUTION

1.INFANC Birth to Trust vs. -learning to trust others -mistrust, withdrawal

Y 18 mos mistrust estrangement
2.EARLY 18 mos Autonomy vs. -self control without loss of -compulsive restraint
CHILDHO to 3 yrs shame and self-esteem compliance
OD doubt -ability to cooperate and -willfulness and defiance
express oneself
3.LATE 3 to 5 Initiative vs. -learning the degree to -lack of self- confidence
CHILDHO yrs guilty which assertiveness and pessimism, fear of
OD purpose influence the wrongdoing
environment -over control and over
-beginning ability to restriction of own
evaluate one’s own activity
behavior
4. 6 to 12 Industry -beginning to create, -loss of hope, sense of
SCHOOL yrs vs. develop and manipulate being mediocre-
AGE inferiority-developing sense of withdrawal from school
competence and and peers
perseverance
5.ADOLE 12 to Identify vs. role - coherent sense of self -confusion,
CENCE 20 yrs confusion -plans to actualize one’s indecisiveness and
old abilities inability to find
occupational identify
6.YOUNG 18 to Intimacy vs. -intimate relationship with -impersonal
ADULTHO 25 yrs Isolation another person relationships
OD commitment to work and -avoidance of
relationships relationship, career or
lifestyle commitments
7.ADULT 25 to Generativity -creativity, productivity, - self-indulgence, self
HOOD 65 vs. stagtation concern for others concern, lack of interest
and commitments
8.MATUR 65 yrs Integrity vs. -acceptance of worth and -sense of loss, contempt
ITY to despair uniqueness of one’s own for others
death life
-acceptance of death

COGNITIVE THEORY
C. Piaget, Jean (1896-1980)
Believes that cognitive development refers to the manner in which people learn to think,
reasons, and use language.

ASSIMILATION- process through which humans encounter and react and react to new
situations by using the mechanism they already possess.
ACCOMODATION- process of change whereby cognitive processes mature sufficiently to
allow the person to solve problems that were insolvable before.
ADAPTATION- or coping behavior is the ability to handle demands made by the
environment.
 PHASES OF COGNITIVE DEVELOPMENT
PHASE AGE SIGNIFICANT BEHAVIOR
1.Sensorimotor Birth to 2 yrs -Infant develops physically with
gradual increase in the ability to
think and use language;
progresses from simple reflex
responses thru repetitive
behaviors to deliberate and
imaginative activity.
1.a. STAGE 1 Birth to 1 month -most action is reflexes
Use of Reflexes
1.b.STAGE 2 1 to 4 months -perception of even is centered
Primary Circular Action on the body-objects are
extension of self
1.c. STAGE 3 4 to 8 months -acknowledge the external
Secondary Circular environment
Action -Actively make changes in the
environment.
1.d.STAGE 4 8 to 12 months -can distinguish a goal from a
Coordination of means of attaining it.
Secondary schemata
1.e.STAGE 5 12 to 8 months -tries and discovers new goal and
Tertiary Circular Action ways to attain goals
-rituals are important
1.d.STAGE 6 18 to 24 yrs -Interprets the environment by
Inventions of new mental image-use make believe
means and pretend play
2. Preconceptual Phase 2` to 4 yrs -uses an egocentric approach to
accommodate the demands of an
env’t
-everything is significant and
relates to “me”
-explores the env’t
-language dev’t is rapid
-associates words with object
3. Intuitive 4 to 7 yrs -ego centric thinking diminishes
Thoughts phase -thinks of one ides at a time
-includes others in the env’t
-words express thought
4.Concrete 7 to 11 yrs -solves concrete problems
Operations Phase -begins to understand
relationships such as size
-understand rights and left
 -cognizant of viewpoints
5.Formal 11 to 15 yrs -use rational thinking
Operations Phase -reasoning is deductive and
futuristic

MORAL THEORY
D. Kohlberg, Lawrence
Addresses moral development in children and adults

MORAL- relating to right and wrong

MORALITY- a doctrine or system denoting what is right and wrong in conduct, character or
attitude.
MORAL DEVELOPMENT- pattern of change in moral behavior with age.

I. PREMORAL/PRECONVENTIONAL LEVEL- children are responsive to cultural rules and

labels of good and bad, right and wrong. They believe in reward and punishment.
II. CONVENTIONAL LEVEL- individual is concerned about maintaining the expectations of the
family.
- Conformity to one’s expectations as well as society.
III. POSTCONVENTIONAL/AUTONOMOUS/PRINCIPLED LEVEL- people make an effort to
define values and principles without regards to outside authority or to the expectations of
other.

STAGES OF MORAL DEVELOPMENT

LEVEL AND STAGE DEFINITION EXAMPLE

1.LEVEL I:Preconventional
a. STAGE I: Punishment and
Obedience Orientation
b. STAGE II: Instrumental-
Relatives Orientation
2. LEVEL II: Conventional
c. STAGE III: Interpersonal
concordance (good boy, nice
girl)
d. STAGE IV: law and Order
Orientation
-The activity is wrong of
one is punished, and the
activity is right if one is
not punished
-Action is taken to satisfy
one’s needs
-Action is taken to
pleasure another and
gain approval.
-Right behavior is
obeying the law and the
-A nurse follows a order
to physician’s order so
as not to be fired
-A client in hospital
agrees to stay in bed if
the nurse will bur the
client newspaper
-A nurse gives elderly
clients in hospital
sedatives at bedtime
because the night nurse
wants all clients to sleep
night.
-A nurse does not
permit a worried client

3. LEVEL III:
Post conventional
e. STAGE V: Social Contract,
Legalistic Orientation
f. STAGE VI: Universal-
Ethical Principles
rules
-Standard of behavior is
based on adhering to
laws that protect the
welfare and rights of
others
-Personal values and
options are recognized
and violating the rights
of others is avoided
-Universal moral
principles are
internalized. Person
respects other humans
and believes that
relationships are based
on mutual trust.
to phone calls after 9
pm
-A nurse arranges for a
religious client to have
privacy for prayer each
evening
-A nurse becomes an
advocate for a
hospitalized client by
reporting to the nurse
supervisor o
conversation in which a
physician threatened to
with hold assistance
unless the client agreed
to surgery.

SPIRITUAL THEORY
e. Fowler,James
“Faith stages evolve from a combination of knowledge and values”
Describes the development of faith

FAITH- as active mode-of-being-in-relation to another or others in which we invest

commitment, belief, life, love, risk and hope.

STAGES OF SPIRITUAL DEVELOPMENT

STAGE AGE DESCRIPTION

1.Undifferentiated
2. Intuitive-Projective
0 to 3 yrs. -infant unable to formulate concepts
about self on the environment
4 to 6 yrs -a combination of images and belief given
by trusted others mixed the child’s own
experience and imagination
3.Mythic-Literal 7 to 12 yrs -private world of fantasy and wonder,
symbols refer to something specific,
dramatic stories used to communicate
spiritual meanings
4.Synthetic Adolescent -world and ultimate environment
Conventional or adult structures by the expectation and
judgments of others; interpersonal focus
5.Individuating -constructing one’s own explicit system.
Reflexive After 18 yrs -high degree of self-consciousness
6.Paradoxical After 30 yrs -awareness of truth from a variety of
consolidative viewpoints
7.Universalizing Maybe -becoming an incarnation of the principles
never of love and injustice

“ Do not look back and grieve over the PAST for it is gone and do not be troubled
about the FUTURE for it is yet to come. Live in the PRESENT,
and make it so beautiful that it will be worth
remembering”- Ida Scott Taylor
 PLT College Inc
Institute of Health Sciences- College of Nursing

Psychiatric Mental Health Nursing

Psych Lecture Series # 2 (Prepared By: Prince Rener V. Pera, RN)

MENTAL HEALTH
 Balance in a person’s internal life and adaptation to reality.
 A state of well being in which a person is able to realize his potentials.

Characteristics: (MEATS ADO)

 Maximization of Potentials
 Environmental Mastery
 Attitude of self-acceptance
 Tolerance to uncertainties of life
 Stress Management
 Autonomous and independent behavior
 Development, growth and self-actualization
 Orientation to Reality

MENTAL ILLNESS
• A state of imbalance characterized by a disturbance in a person’s thoughts, feelings and
behavior.

• Poverty and abuses are major factors which increases the risk of mental illness in the
home.

Characteristics (MENTAL ILLNESS)

M-arked change in the personality over time
E-xterme high and low
N-umerous unexplained ailments
T- hinking/talking about suicide
A- social, no social support
L- ack of friends

I- nability to cope with problems and ADL’s

L- agi dapat ako! (Extreme self centeredness)
L- ungkot me! (Prolonged severe depression)
N- ot normal senses
E- xcessive anxiety
S- trong resistance to help
S- trange/grandiose ideas
 PSYCHIATRIC NURSING
• Interpersonal process whereby the professional nurse practitioner through the use of
self, assist an individual family, group or community to promote mental health, to
prevent mental illness and suffering, to participate in the treatment and rehabilitation of
the mentally ill and if necessary to find meaning in these experiences.

• It is both Science and an Art.

Science in Psychiatric Nursing.

• The use of different theories in the practice of nursing, serves as the science of
psychiatric nursing.

Art in Psychiatric Nursing.

• The therapeutic use of self is considered as the art of psychiatric nursing.

Core of Psychiatric Nursing.

• The interpersonal process, that is, the human to human relationship, is the core of
psychiatric nursing.

Clientele in Psychiatric Nursing.

• The individual, family, and the community, both mentally healthy and mentally ill.

Mental Hygiene
• It is the science that deals with measures to promote mental health, prevent mental
illness and suffering and facilitate rehabilitation.

THERAPEUTIC USE OF SELF

• THERAPEUTIC USE OF SELF SERVES AS THE NURSES’ MAIN TOOL.

CORE CONCEPT
• It is the positive use of one’s self in the process of therapy.It requires self-awareness.

BASIS OF THERAPEUTIC USE OF SELF

JOHARIS WINDOW

Known to self Not known to self

Known to others Public self Semi-public self

I II

Not known to Private self Area of the unknown

others III IV
PSYCHOSOCIAL Assessment
 Idea of the current emotional state, mental capacity, and emotional or
behavioural function
 Used also for planning interventions and for the evaluation of the effectivity of
each interventions employed.
A) History
a) age and developmental stage
b) culture
c) spiritual beliefs
d) previous history
B) General Appearance
a) hygiene and grooming
b) appropriate dress
c) posture
d) eye contact and facial expression
C) Motor Behavior
a) Echopraxia- imitation of one movements of another person
b) Catatonia- motor anomalies in non-organic causes
1. Catatonic Stupor- markedly slowed motor activity
2. Catatonic Rigidity- voluntary assumption of rigid postures
3. Catatonic Posturing- voluntary assumption of inappropriate or bizarre posture
generally maintained for long period of time.
4. Cerea Flexibilitas/ Waxy Flexibility- the person can be molded in a position that is
then maintained
c) Negativism- motiveless resistance to all attempts to be moved or to all instructions
d) Cataplexy- temporary loss of muscle tone and weakness precipitated by a variety of
emotional states; loss of muscle power at times of sudden emotion.
e) Stereotypy- repetitive fixed pattern of physical action or speech; combination of
echolalia and echopraxia.
f) Mannerism- ingrained, habitual involuntary movements
g) Automatism- automatic performance of an act/s generally representative of
unconscious symbolic activity.
h) Hyperactivity/ Hyperkinesis- restless, aggressive, destructive activity often
associated with some underlying organic pathology.
i) Hypoactivity/ Hypokinesis- decreased motor and cognitive activity as in psychomotor
retardation, visible slowing of speech, thought and movements.
D) Speech
1. Pressure of Speech- rapid speech that is difficult to interpret
2. Poverty of Speech- restriction in the amount of speech used; replies maybe
monosyllabic.
3. Dyprosydy- loss of normal speech melody
E) Mood and Affect
Affect- Expression of emotion as observed by others.
 a) Appropriate Affect- Normal condition in which emotional tone (Process/Feeling) is in
harmony with the accompanying idea (Content)
b) Inappropriate Affect- disharmony between the emotional feeling tone and idea,
thought or speech that accompany it.
c) Blunted Affect- severe reduction in the intensity of externalized feeling tone.
d) Flat Affect- absence or near absence of any signs of effective expression, voice is
monotonous, face is immobile, lacks or no expression at all.
e) Labile Affect- rapid and abrupt changes in emotional feeling or tone usually
unrelated to external stimuli.
f) Restricted Affect- Usually serious or somber
g) Apathy – dulled emotional tone.
h) Ambivalence – presence of two opposing feelings.
i) Depersonalization – feeling of strangeness towards one’s self
j) Derealization – feeling of strangeness towards the environment
Mood- Pervasive, sustained emotion, subjectively experienced and reported by the
patient, as well as observed by others.
a) Dysphoric Mood- Unpleasant mood
b) Euthymic Mood- Normal Range of mood
c) Expansive Mood- Expression of one’s feeling without restraint
d) Irritable Mood- Easily annoyed and provoked to anger
e) Elevated Mood- air of confidence and enjoyment
f) Euphoria- intense elation with feelings of grandeur
g) Ecstasy- feelings of intense rupture
h) Depression- psychopathological feeling of sadness
F) Thought Processes and Content
Thought Process-
Content-
a) Circumstantiality- excessive unnecessary details then giving the answer
b) Delusions- Fixed False beliefs not based on reality
 Delusions of Poverty- belief that one is bereft or will be by material possessions
 Somatic Delusions- involves functioning of the body
 Persecutory Delusions- belief that one is harassed, cheated or persecuted
 Delusions of Grandeur- exaggerated conception of one’s importance, power or
identity; belief that someone has a special power.
 Delusions of Self- Accusations- false feelings of remorse or guilt
 Delusions of Control- false feeling that one’s will, thoughts or feeling are being
controlled by external forces
 Religious Delusions- feeling of the client that he is god.
 Nihilistic Delusions- feeling that the world is to end
 Referential Delusions- False feeling that an object is blaming the client for a
certain problem without any factual basis; belief that passages in songs, patterns
of clouds in the sky, comments of passerby refer specially to them.
c) Flight of Ideas- rapid process where patient’s thoughts are fragmented and move
from one unconnected topic to another
 d) Loose Association- stringing together of unrelated topics with a vague connection.
e) Tangential Thinking- wandering off the topic and not providing the information;
failure to reach a goal or stick to the original point.
f) Thought Blocking- stopping abruptly in the middle of a sentence, sometimes unable
to continue the idea.
g) Autistic Thinking- preoccupation with inner private world.
h) Psychosis- inability to distinguish reality from fantasy.
i) Magical Thinking- thinking that is similar to that of the preoccupational stage of
children.
j) Neologism- a word or expression invented by the patient.
k) Word Salad- incoherent mixture of words and phrases
l) Hypochondria- exaggerated concern over one’s health that is not based on real
organic pathology, but rather on unrealistic interpretation of physical signs or
sensation as abnormal
m) Obsession- pathological persistence of an irresistible thought or feeling that can not
be eliminated from consciousness by logical effort, usually associated with anxiety.
n) Phobia- persistent, irrational, exaggerated and invariably pathological dread of some
specific type of stimulus or situation.
o) Mutism- voicelessness without structural abnormalities
p) Echolalia- psychopathological repetition of specific words or phrases of one person
by another; echoing of a sound heard
q) Verbigeration- meaningless repetition of specific words or phrases
r) Clang Association- association of words similar in sound but not in meaning.
s) Perseveration – persistence of a response to a previous question.
t) Derailment- going off the point or subject.
G) Memory
a) Confabulation – filling in memory gap.
b) Amnesia – inability to recall past events.
c) Anterograde amnesia – loss memory of the immediate past.
d) Retrograde amnesia – loss of memory of the distant past.
e) Déjà vu – feeling of having been to place which one has not yet visited.
f) Jamais vu – feeling of not having been to a place which one has visited.

“ Do not look back and grieve over the PAST for it is gone and do not be troubled
about the FUTURE for it is yet to come. Live in the PRESENT,
and make it so beautiful that it will be worth
remembering”- Ida Scott Taylor