1

2
• Sigmund Freud
(based his theory of development on
observation
of mentally ill adults)
1. ORAL STAGE
- The erotic zone or the source of security
and satisfaction is the mouth.
a. AUTISTIC PHASE (Birth- 3months)
- characterized by marked passivity on
the part of the infant.

3
b. SYMBIOTIC PHASE ( 3-18 months)
- Characterized by dependency
- He termed the infant period the oral
phase because the infant is so interested
in the oral stimulation or pleasure.
-He sucks for enjoyment or relief of
tension as well as nourishment.
- An individual who continues to be
mouth- centered far beyond the age
when the mouth should have ceased to
be a pleasure
4
2. ANAL STAGE (18- 32 months)
- The child’s interest widens, and his
main interest is focused on anal region.
- He finds pleasure in both the retention
of feces and in defecation.
-This anal interest is part of the child
discovery of self a way of exerting his
independence.
- Person who later in life feel a need to
accumulate large number of possessions
(misers) are, according to Freudian
theory, still anal dependent. 5
- A person who gives things away too freely
is anal dependent; he still delights in the
feeling of releasing substances from his
body.
- Reaction formation must be used as a
defense because it permits the toddler to
sacrifice what has been dear to him.
- He gives up part of his self- esteem in
order to please his parents.
- Thus the toddler strives to control his
impulse to urinate and defecate.
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- As he succeeds, he feels greater self-
esteem and self- confidence.
- When he fails, he feels guilt, shame and
distress.
- A number of unpleasant characteristics
like obstinacy, selfishness, bossiness
and sadism make up the picture.
- A child may throw temper tantrums.
He is quite ambivalent and may love and
hate alternatively.

7
- Identification and regression are the
prominent defense mechanism.
- Anal type of personality is sometimes seen in
obstinate and parsimonions adults.
- A child is toilet trained for day control at 18-
24 months. Night control at 2 ½ - 3 years.
- Culture challenge is toilet training.
- Ambivalence- child enjoys his urine, feces
but his mother disapproves such behaviors he
has to satisfy parents yet at the same time
feels resentment towards them for not
allowing him to defecate when he pleases.

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3. PHALLIC STAGE (3-4 years & ends at 5-7
years)
- Erotic zone shift from the anal to the genital
area (penis and clitoris)
- The child exhibits ambivalence plus curiosity
and exhibitionism.
- He continues to believe readily in magic and
becomes preoccupied with the genitals and
sex differences.
- The boy fears that he might lose his penis
while the girl feels that she has lost hers.

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- He develops some anxiety about his genitalia
fearing that paternal relationship involves loss
at his prized anatomical parts. The anxiety
arises because he discovers that some people
do not have such a part.
- This fear is termed as castration complex.
- A girl begins to be inferior to boys during this
stage because he has no penis (penis envy).
She may assume that castration has already
occurred as a punishment which has occurred
in the past.

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- This resentment causes her to turn favorably
toward father, hoping that he will give her a
penis to replace the one she has lost.
- The little girl begins to disengage her
affection from the mother when she becomes
aware of her body’s inadequacies.
- She resents the mother whom she holds
responsible for her lacking of a penis.
- During this period the little girl begins to flirt
with father.

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- She attempts to imitate mother’s
feminine roles in an effort to capture
father’s interest.
- The successful termination of the
Oedipal, Phallic or Genital phase marks
the beginning of the child’s more mature
attempts to cope up the world.
- The OEDIPUS COMPLEX is
characterized by an attraction to the
parent of the opposite sex, accompanied
by jealousy and rivalrous hostility toward
the parent of the same sex.
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- Masturbation is common to reassure
himself that his penis is still intact.
- Reaction Formation & Repression
are the defense mechanism.

4. LATENCY STAGE (7-12 years)

- The erogenous area remains in the
Phallic area.
-There is an increasing accumulation
of knowledge of development of physical
ability.

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-Latency child already has good
conscious fear of death.
-Relative decrease in sex interest.
-Identification of the parent of the
same sex and more differentiation
along masculine and feminine lines.
-Turns to school and peer group.

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-Latency child already has good
conscious fear of death.
-Relative decrease in sex interest.
-Identification of the parent of the
same sex and more differentiation
along masculine and feminine lines.
-Turns to school and peer group.

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-Intellectualization-defense
mechanism.
-Start forming ideals and superego
formation begins.
-Obsessiveness and impulsiveness
are observed.
-Secret years
-Beginning of collection, club and
gang formation.

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6. Cultural
-Quest for status is obvious at this stage
level.
-Rationalization and sublimation-
defense mechanism.
-Through reaction formation , he
experiences mothers attitudes and value
as his own and finally during latency
incorporates learning of parental and
societal values that he acts upon these
and performs out of personal choice.
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INFANT
Psychosexual Stage:
Oral Stage: Child explores the world by using
mouth, especially the tongue. Lack of oral
experiences now may lead to alcoholism or
obesity (oral dependency) later in life.
Nursing Implication:
-Provide oral stimulation by giving
pacifiers;do not discourage thumb sucking.
-Breastfeeding may provide more stimulation
than formual feeding as it requires the
infant to expend more energy.
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TODDLER
Developmental Task:
Anal Stage: Child learns to control
urination and defecation. Constipation or
obsessive-compulsive personality may become
chronic problems in later life effects of this
period.
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.
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PRESCHOOLER
Psychosexual Stage:
Phallic Stage: Child learns sexual identity
through awareness of genital area. Difficulty
with sexual identity and authority figures may
become problems later if period is interrupted.
Nursing implication:
-Accept child’s sexual interest, such as
fondling his or her own genitals, as a
normal area of exploration.
-Help parents answer child’s question
about birth or sexual differences.

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SCHOOL-AGE
Psychosexual Stage:
Latent Stage: Child’s personality
development appears to be non-active
or dormant.
Nursing Implication:
-Help the child have positive
experiences so his self-esteem
continues to grow and he prepares
for the conflicts of adolescence.

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ADOLESCENT
Psychosexual Stage:
Genital Stage: Adolescent develops sexual
maturity and learns how to establish
satisfactory relationships with the opposite
sex. Negative experiences may lead to
unsatisfactory sexual adjustment later and
problems such as frigidity or impotence.
Nursing Implication:
- Provide opportunities for the child to
relate with opposite sex.
- Allow child to verbalize feelings about
new relationships.
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By: Erik Erickson: Clinician, educator, theorist and artist
Born in 1902 in Frankfort, Germany.
His father abandoned his mother prior to
his birth.

1. Sense of Trust Vs. Mistrust -> Hope= 0-1 year old

- The infant whose needs are not met when they
arise, whose discomforts are quickly removed,
who is cuddled, fondled, played with and talked to
loved ones to accept the world as a safe place and
people as helpful and dependable.
23
However, rejecting the care is
inconsistent, inadequate and rejecting it
fosters a basic mistrust- the infant
becomes fearful and suspicious of the
world and of people.
- The problem of Trust vs. Mistrust is not
resolved forever but arises again at each
successive stage of development.
Example:
- Trustful at first -> Mistrustful when
parents were divorced.

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 - Mistrustful at first -> Trustful through the
help of the teacher
- John unable to form a sense of trust -> He
was moved so frequently and he never had the
chance to develop relationship-> The
implication on prolonged hospitalization and
institutionalized children.

Sense of Trust
- Requires a feeling of physical comfort and
minimum experience with fear and
uncertainty.

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- Develops when there is an adequate
relationship with the primary caretaker.
- To assess whether or not an infant has
trust, behavior may be noted at feeding
time. The infant is hungry and begins to
cry and let the caretaker know his or her
need. The infant who has trust may stop
crying as the sounds of the caretaker
preparing the feeding was recognized, or
at least, the crying changes in intensity.
An infant with trust can tolerate small
frustrations.
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- Occasionally, the trusting infant cries loudly and
is demanding. He or she is constantly testing the
world in order to discover its predictability and if it
can be tested. It is this rationale that is used to
answer the question, “Will it spoil my baby by
always responding to his cry?”. Promptly
attending to an infant’s cry teaches trust by
relieving tension and does not “spoil” a baby. The
key is how the caretakers respond as the infant
does not always need to be picked up and held.
Quite often, the infant on using some forms of
touch along with a soothing verbal response is
sufficient to let the infant know that his or her
environment is reliable.
- If he can rely on consistency, continuity and
sameness of experience, he has confidence.

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Trust versus Mistrust -> Nursing Implication
- When the infant is hungry, the mother feedds
and makes him comfortable again; he is wet
and the mother changes him and makes him
comfortable again; he is cold and the mother
holds and warms him and makes him
comfortable again. By this process, he learns
to trust that when he has a need, or is in
distress, a person will come to take care of
him.
- By the way that the infant is handled, fed,
talked to, and hold, he learns to love and be
loved.

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- The infant who has a variety of caretakers, who
sometimes is fed on a rigid schedule, if the
feedings are not sufficient, who sometimes is
treated roughly and has difficulty learning to
trust anyone -> MISTRUST
- If the first developmental step is inadequate,
this inadequacies will pervade all future steps.
- If someone speaks to him in a harsh tone or
is sudden and spasmodic in his movements,
the infant is frightened. He has received his
first lesson in mistrusting others.

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- Passively caring for an infant, never
talking to him or touching or stroking
him while feeding and changing him, is
the same as not being with him at all.
- An infant learns to trust others through
the relief of his basic need, i.e. he learns
to trust (others) those who give him
pleasant sensations.
- If care is consistent -> sense of trust is
developed.

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Needs during the first year:
1. Sensory Stimulation
- Sensory stimulation is necessary for the
immature organism if the sensory organs and
nerve fibers are to develop normally.
- Infants need to be stimulated by a change of
environment, by a change in position, by
contact with various textures of materials, by
sights and sounds and by human contact. If
they do not receive such stimulation in their
daily care, they will not grow and develop
normally.

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 NEEDS:
Hearing, sight, taste (one at a time), touch
How can their needs for stimulation be
met?
2. Sense of Autonomy vs. Shame and doubt ->
Will power
- The child takes pride in his new
accomplishments and wants to do everything
for himself, whether it is pulling the wrapper
off a piece of candy, selecting his vitamin
tablet out of the bottle of flushing the toilet.

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If parents recognize the toddlers need to do
what he is capable of doing at his own pace
and in his own time, then the child develops a
sense of being able to control his muscles, his
impulses and himself. He is an independent
person. When his caregivers are impatient
with him, however, and do everything for him,
they enforce a sense of shame and doubt. If he
is never allowed to do eventually, he doubts
his ability to do; he stops trying and cannot do.
If the child leaves this stage with less
autonomy than shame and doubt, he will be
handicapped in his attempt to achieve
independence in adolescence and adulthood.
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Example:
Mary has a mother who is a perfect
housekeeper. Everything was out of
reach. Mary could not explore the
house. As a school- age child she still
stands apart from the group has no
confidence in her ability to achieve.
Sense of Autonomy
- By this time, the toddler discovers that
he or she and the mother are separate
persons and begins to explore the
expanded world.
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- Autonomy is interpreted as a sense of one’s
self, or sense of separateness, and a sense of
“I”.
- The toddler is self- loving, uninhibited,
impulsive and energetic. He experiments with
abandon and explores everything. When
wants are frustrated, the toddler has a
tantrum. He resists strongly any type of
immobilizing restraint.
- He needs to be given choices whenever
possible in order that autonomy can flourish in
spite of the restricted environment.

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- Shame and doubt -> result in the toddler
responding with behaviors of withdrawal and
giving the appearance of being shy. The toddler is
so shamed that he or she feels embarrassed,
exposed and very small. The toddler wants to
hide and is angry with self. Doubt is expressed as
fear, uncertainty, and lack of self- confidence.
- The idea of doubt in this stage is associated with
the discovery or being aware of having a front
and back, a “behind”. The toddler realizes he or
she has control over front and more over his or
her behind. The behind is dominated by the will
of others, for that is where he or she is sparked
when he or she oversteps his or her autonomy.
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3. Sense of Initiative vs. Guilt -> Purpose=
3-6 years
-Learning initiative is learning how to do
things or learning that is fun to do
things.
- The child can initiate motor activities of
various sorts on his own and no longer
merely responds to or imitates actions of
other children same with language and
fantasy activities.

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- When children are given much
freedom and opportunity to initiate
motor play such as running, bike
riding, sliding and wrestling or are
exposed to such play materials as
finger paints, sand, water and play
dough, their sense of initiative is
reinforced.
- Initiative is also encouraged when
parents answer their child’s questions
and do not deride or inhibit fantasy or
play activities.
- If the child is made to feel that his
motor ability as bad, that his questions
are nuisance and that his play is silly and
stupid, he may develop a sense of guilt
over self initiated activities that will
persist in later life.
- Provide a climate for exploring new
learning experience which is desirable.
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- Example:
Jill is not allowed much
experimentation as a
preschool at high school.
She’s unable to look at a
problem and solution
without clues and guidance. -
> Guilt
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Sense of Initiative
- Throughout the preschool years, the
child is developing a conscience that
begins to pass judgment on actions and
thoughts.
- He now begins to feel guilt. Guilt is
defined as feeling responsible for things
he is not responsible for, feeling easily
frightened about what he wants to do,
and feeling deserving of punishments.
- Guilt is illustrated in the child believing that
illness resulted from not wearing boots as the
parent requested.

- The preschool then served as a social group

where the child can learn social roles
necessary for coexistence of others. The group
situation stimulates learning to wait for one’s
turn, to care for one’s belonging and to share
responsibility for community property (helping
to put away materials, handling certain things
with care such as flowers, plants and pets).

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- Observation of children at a
preschool reveals the various roles
that occur in interaction with peers.
There is sharing, aggression,
shyness, leadership, dependence,
independence, initiative and guilt.

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4.Sense of Industry vs. Inferiority ->
Competence= 6-12 years
- During the preschool period, the child
was learning initiative= how to do
something. Now he is interested in
learning how to do things well and
correctly. When he is absorbed in a
project, his questions are “ Am I doing a
good job? Am I Doing this right? Is this
good? Do you like this? Is this the right
way to do this?”
- When children are encouraged in their
efforts to make, do, or build practical
things, when they are allowed to finish
their projects and are praised and
rewarded for the results, their sense of
industry grows.
- Children in this age have a strong sense
of duty. They want to engage in tasks in
their social world which they can carry
out successfully and they want their
success to be recognized by adults and
by their peers.
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 - Parents who see their child’s effort at
making and doing as “mischief” or as
“making a mess” help to encourage in
the child a sense of inferiority especially
if the parents or the school expects a
level of achievement which the child is
unable to attain.
Sense of Industry
- Industry is illustrated in that the child
becomes a “worker”. Being productive
gradually supersedes the whims of play.

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- Play is more structured with projects,
group activities and games with rules.
- Has intense devotion to the peer
group. He goes outside the family for
recognition. An adult’s compliment for a
job well done does not mean as much
compared to recognition and a
compliment from a peer. Idealism and
realism, dependence and independence,
quiet restfulness and tremendous
activity.

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• If he experiences a sense of failure
in school tasks, he sees self as
being pulled back toward a
previous but of lesser production.
• There is a strong loyalty and an
intense interest in achieving group
goals. Group projects to raise
money are especially successful at
this stage.
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Through groups, the child
learns both to and to
cooperate with others, He
begins to form attitudes and
beliefs that may be in conflict
with his or her parents.

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 Parents need to allow the school-age
child to join a variety of groups. Besides
learning from others, it gives the child an
opportunity to try out different roles. He
maybe a leader in some groups and a
follower in others. Belonging to groups is
essential for meeting developing needs
and for creating in the school age child a
wholesome attitude toward self as a
person.
5. SENSE OF IDENTITY VS. ROLE
CONFLICT-FIDELITY=12-18 YEARS
-The adolescent wants to clarify who he
is and what his role in society is to be,
what kind of person he will be. His
attitude toward life is “What will this
mean to me?” Success in this period
brings self-esteem, an attitude toward
the self that is essential to be normal
breaking away from tendency upon his
parents and to planning for his future.

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-The danger is self-diffusion, for
he faces at the time and in his
dreams of the future a life full of
conflicting desires, possibilities
and chances
5. SENSE OF IDENTITY VS. ROLE
CONFLICT-FIDELITY=12-18
YEARS
-The adolescent wants to clarify
who he is and what his role in
society is to be, what kind of
person he will be. His attitude
toward life is “What will this
mean to me?”
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Success in this period brings self-esteem,
an attitude toward the self that is
essential to be normal breaking away
from tendency upon his parents and to
planning for his future.
-The danger is self-diffusion, for he faces
at the time and in his dreams of the
future a life full of conflicting desires,
possibilities and chances
Sense of Identity
 The adolescent not only considers future
roles but also evaluates previous
identification as a person.
 Identity is the result of a synthesis of the
past and the future.
 Identity is also achieved when there is
sameness between that which the
individual conceives self to be that which
he perceives others to see in or expect of
him.

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-The childhood sense of
belonging is lost in the necessity
of changing from childhood
dependency to adult
responsibility for his own actions
and those of others who are
dependent upon him.

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4 Main Areas in which an adolescent
must make gains to achieve a sense
of identity
1. Accepting his changed body
image.
2.Establishing what kind of person
he is going to be
3.Making a career decisions
4. Gaining emancipation from his
parents
- The appearance of body becomes a
preoccupation with the adolescent.
- the adolescent seeks recognition and
assurance from peers as he or she
believes they understand him.
- Peers provide not only support but
they also provide a testing group for
trying out new roles.
- Friends and peers become most
important as the adolescent searches for
new and satisfactory relationship
outside the family.
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6. Sense of Intimacy vs. Isolation -> Love= 18-
25 years
- Youth develops a sense of intimacy with
individuals of his own and of opposite sex and
with himself.
- Failure to establish such intimacy results in
psychological isolation-keeping relations with
others on a formal basis which lacks warmth.
This is likely to result in failure on all the steps
in intimacy which lead to selection of a
marriage partner or dating, courtship, and
engagement and to satisfaction in marriage.

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 -Intimacy can be expressed on a
personal level as:
 Friendship
 Sexual Intimacy
 Intimacy of parent-child relationship
-On a social level-it is expressed as
concern for the welfare of others.
-With this sense of freedom to love and
be loved people are isolated and may
develop a sense of alienation from
family, friends and society.
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7. Generativity vs. Self
Absorption-Care
- People are concerned with
creating the next generation and
providing the necessary
nurturing and caregiving.

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Task Includes:
1. Preparation for assuming the
role of parent.
2. Participating in the growth of
children
3. Adapting to the reality and
parenthood
4. Adopting children.
 5. Being friends to adolescents
6. Teaching, nursing

-Self absorption is minimized which

involvement of the self with others takes
place.
-Growth of the personality, as a person
seeks balance between commitment to
others leads to sense of productiveness
and fulfillment.

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8. Ego integrity vs. Despair-Wisdom=65
years until death
-Staying productive and involved in the
welfare of others increases the
satisfaction or ego integrity of elderly
people.
-In most cases an elderly person’s
physical and mental abilities gradually
decline imposing limitations and
uncertainty his sphere of activity. As
people confront the limitation they must
balance acceptance against despair.
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 -Wisdom and a sense of satisfaction in
their accomplishments came to those
who succeed in the search for personal
meaning.

ERIKSON’S DEVELOPMENTAL STAGES

TRUST VS. MISTRUST
BEHAVIOR INDICATING TRUST
1. Requesting assistance and expecting to
receive it.
2. Saying you believe another person

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3. Sharing time, opinions and
experiences.
BEHAVIOR INDICATING MISTRUST
1. Restricting conversation to
superficialities.
2. Refusing to provide a person with
information.
3. Being unable to accept assistance.

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 AUTONOMY VERSUS SHAME AND DOUBT
BEHAVIOR INDICATING AUTONOMY
1. Accepting the rules of a group but also
expressing disagreement when its felt.
2. Expressing one’s own opinion.
3. Accepting deferment of a with fulfillment
easily.
BEHAVIOR INDICATING SHAME AND DOUBT
1. Failing to express needs.
2. Not expressing one’s own opinion when
opposed.
3. Being overly concerned about being clean.

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 INITIATIVE VERSUS GUILT
BEHAVIOR INDICATING INITIATIVE
1. Starting projects eagerly.
2. Expressing curiosity about many things.
3. Demonstrating original thoughts.
BEHAVIOR INDICATING GUILT
1. Imitating others rather than developing
independent ideas.
2. Apologizing and being embarrassed over a
small mistake.
3. Verbalizing fear about starting a new project.

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 INDUSTRY VERSUS INFERIORITY
BEHAVIOR INDICATING INDUSTRY
1.Completing a task once it has been
started.
2. Working well with others.
3. Using time effectively.
BEHAVIORS INDICATING INFERIORITY
1.Not completing a task started.
2. Not assisting with the work of others.
3. Not organizing work.

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 IDENTITY VERSUS ROLE CONFUSION
BEHAVIOR INDICATING IDENTITY
1. Establishing relationships with the same sex
and then the opposite sex.
2. Asserting independence.
3. Planning realistically for future role.
BEHAVIOR INDICATING ROLE CONFUSION
1. Failing to assume responsibility for directing
one’s own behavior.
2. Accepting the values of others without question
3. Failure to set goals in life.

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 INTIMACY VERSUS ISOLATION
BEHAVIOR INDICATING INTIMACY
1. Establishing a close relationship with another
person.
2. Accepting sexual behavior as desirable.
3. Commitment to that relationship even in times
of stress and sacrifice.
BEHAVIOR INDICATING ISOLATION
1. Remaining alone.
2. Avoiding the establishment of close personal
relationships.
3. Avoiding the sex role by mennerisms and
dress.

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GENERATIVITY VERSUS STAGNATION
BEHAVIOR INDICATING GENERATIVITY
1. Willingness to share with another
person.
2. Guiding others.
3. Establishing a priority of needs
recognizing both self and others.

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BEHAVIOR INDICATING STAGNATION
1. Talking about oneself instead of
listening to others.
2. Showing concern for oneself
inspite of the needs of others.
3. Inability to accept
interdependence.
INTEGRITY VERSUS DESPAIR
BEHAVIOR INDICATING INTEGRITY
1. Using past experience to assist others.
2. Maintaining productivity in some
areas.
3. Accepting limitations.
BEHAVIOR INDICATING DESPAIR
1. Crying and being apathetic.
2. Not accepting changes.
3. Demanding unnecessary assistance and
attention.
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AN OPERATIONAL CHILD CAN ALSO
MENTALLY ARRANGE OBJECTS ALONG
SOME QUANTITATIVE DIMENSIONS SUCH
AS SIZE ON WEIGHTS, COLOR, SHAPE
KNOWN AS “SERIATION”
HE UNDERSTANDS THE VALUE OF RULE
AND BASES JUDGMENT ON REASON.
REASONING AT THE LEVEL IS INDUCTIVE
(SPECIFIC & GENERAL)
TABLE 2.3 ADULT MANIFESTATIONS OF ERIKSON’S
EIGHT STAGES OF DEVELOPMENT
LIFE STAGE ADULT BEHAVIOR ADULT BEHAVIORS
REFLECTING REFLECTING
MASTERY DEVELOPMENTAL
PROBLEMS

TRUST VS. REALISTIC TRUST OF SUSPICIOUSNESS OF

MISTRUST SELF AND OTHERS OTHERS
(0-18 MONTHS) CONFIDENCE IN TESTING OF OTHERS
OTHERS FEAR OF CRITICISM
OPTIMISM AND AND AFFECTION
HOPE DISSATISFACTION
SHARING OPENLY AND HOSTILITY
OPENLY WITH SENSE OF
OTHERS OTHERS BEING
RELATING TO EVIL
OTHERS FEAR OF
EFFECTIVELY SHARING AND
ASKING FOR
HELP
PROJECTION OF
BLAME AND
UNDESIRABLE
FEELINGS
WITHDRAWAL
FROM OTHERS
OR OVERTLY
TRUSTING OF
OTHERS
 BEING GULLIBLE
BEING NAIVE
SHARING TOO
QUICKLY AND EASILY

AUTONOMY VS. SELF CONTROL AND SELF DOUBT AND

SHAME AND DOUBT WILL POWER CONSCIOUSNESS
(18 MONTHS TO 3 REALISTIC SELF DEPENDENCE ON
YEARS) CONCEPT AND SELF- OTHERS FOR
ESTEEM APPROVAL AND
PRIDE AND SENSE OF SENSE OF WORTH
GOODWILL FEELING OF BEING
COOPERATIVENESS EXPOSED
GENEROSITY FEAR OF BEING
TEMPERED WITH ATTACKED
WITHHOLDING SENSE OF BEING
OUT OF CONTROL OF
SELF AND ONE’S LIFE
DELAYED OBSEESSIVE-
GRATIFICATION COMPULSIVE
WHEN BEHAVIORS
NECESSARY JEALOUSY OR
EXCESSIVE
INDEPENDENCE
OR DEFIANCE
DENIAL OF
PROBLEMS
UNWILLINGNESS
TO ASK FOR HELP
IMPULSIVENESS
AND INABILITY
TO WAIT
 RECKLESS
DISREGARD FOR THE
SAFETY OF SELF AND
OTHERS
INITIATIVE VS. GUILT AN ADEQUATE PASSIVITY AND
(3-5 YEARS) CONSCIENCE APATHY
INITIATIVE EXCESSIVE
BALANCED WITH COMPLIANCE
RESTRAINT SELF-RESTRICTION
APPROPRIATE SOCIAL AND SELF DENIAL
BEHAVIORS UNREASONABLE OR
CURIOSITY AND EXCESSIVE GUILT OR
EXPLORATION EMBARASSMENT
HEALTHY FOR ACTIONS, IDEAS
COMPETITIVENESS AND MISTAKES
SENSE OF DIRECTION ASSUMING A ROLE
AS VICTIM
ORIGINAL SELF PUNISHMENT
PURPOSEFUL RELUCTANCE TO
ACTIVITIES SHOW EMOTIONS
UNDERACHIEVEMEN
T OF POTENTIAL
ABSENCE OF SENSE
OF DIRECTION OR
GOOD PLANS OR
IDEAS BUT LACK OF
FOLLOW THROUGH
LITTLE SENSE OF
GUILT DESPITE
ACTIONS
EXPANSIVE
EXPRESSION OF
EMOTIONS(SUCH AS
JEALOUS RANGE)
LABILE EMOTIONS
 SHOWING OFF
EXCESSIVE
COMPETITIVENESS
INDUSTRY VS. SENSE OF FEELING
INFERIORITY COMPETENCE UNWORTHY AND
(6-12 YEARS) COMPLETION OF INADEQUATE
PROJECTS POOR WORK
PLEASURE IN HISTORY
DILIGENCE AND (QUITTING JOBS,
EFFECTIVENESS LACK
ABILITY TO PROMOTIONS,
COOPERATE AND ABSENTEEISM,
COMPROMISE DECLINE IN
IDENTIFICATION PRODUCTIVITY)
WITH ADMIRED WORK VIEWED
OTHERS ONLY AS AN
OBLIGATION
JOY OF INADEQUATE
INVOLVEMENT IN PROBLEM
THE WORLD AND SOLVING SKILLS
WITH OTHERS MANIPULATION
BALANCE OF OF OTHERS TO
WORK AND PLAY PROVIDE FOR SELF
VIOLATION OF
OTHER’S RIGHT
INABILITY TO
COOPERATE OR
COMPROMISE OR
ASSIST OTHERS
LACK OF FRIENDS
OF THE SAME SEX
AND OVERLY HIGH
ACHIEVING
RELUCTANCE TO
ATTEMPT NEW
THINGS FOR FEAR
OF FAILING
FEELING UNABLE
TO GAIN LOVE OR
AFFECTION
UNLESS TOTALLY
SUCCESSFUL
PERFECTIONIST
BEING
WORKAHOLIC
AND TAKING
LITTLE TIME FOR
RECREATION
EXCESSIVE
ORGANIZATION
OF ONE’S LIFE.
IDENTITY VS. CONFIDENT LACK OF
ROLE SENSE OF SELF GIVING UP OF
DIFFUSION EMOTIONAL LONG TERM
(12-18 TO 20 STABILITY GOALS,
YEARS) COMMITMENT BELIEFS, AND
TO CAREER VALUES
PLANNING LACK OF
AND REALISTIC DEFINED
LONG TERM ROLES OR
GOALS LOSS OF
SENSE OF PRODUCTIVE
HAVING A ROLES LACK
PLACE IN THE OF
SOCIETY
ESTABLISHING CONFIDENCE
RELATIONSHIP FEELING OF
WITH THE CONFUSION,
OPPOSITE SEX IDECISION,
FIDELITY TO AND
FRIENDS ALIENATION
VACILLATION
BETWEEN
DEPENDENCE
AND
REBELLION
DEVELOPMENT SUPERFICIAL,
OF PERSONAL SHORT-TERM
VALUES RELATIONSHIP
TESTING OUT WITH THE
ADULT ROLES OPPOSITE SEX OR
DRAMATIC
OVERCONFIDENC
E
ACTING OUT
BEHAVIORS,
INCLUDING
ALCOHOL AND
DRUG USE
SHOWY DISPLAY
OF SEX ROLE
BEHAVIORS
INTIMACY VS. ABILITY TO GIVE ISOLATION
ISOLATION AND RECEIVE
LOVE

(18-25 YEARS) DEVELOPMENT EMOTIONAL

OF DISTANCE IN ALL
COMMITMENT RELATIONSHIP
AND MUTUALITY PREJUDICES AG
WITH OTHERS OF AGAINST OTHERS
BOTH SEXES LACK OF
ESTABLISHED
VOCATION-
MANY CAREER
CHANGES
SEEKING
INTIMACY
THROUGH
SEXUAL
ENCOUNTER(EQ
UATING, SEX
WITH INTIMACY)
OR IMPOSING
TOO MUCH
TOGETHERNESS
IN OPPOSITE SEX
RELATIONSHIP
POSSESSIVENESS
AND JEALOUSY
DEPENDENCY ON
PARENTS,
SPOUSE OR
BOTH
ABUSIVE
TOWARDS LOVED
ONES
INABILITY TO TRY
NEW THINGS
SOCIALLY OR
VOCATIONALLY
 GENERATIVITY PRODUCTIVE, SELF
VS. STAGNATION CONSTRUCTIVE, CENTEREDNESS
OR SELF CREATIVE AND SELF
ABSORPTION ACTIVITY INDULGENCE
(30-65 YEARS)

PERSONAL AND SELF

PROFESSIONAL CENTEREDNESS
GROWTH AND SELF
PARENTAL AND INDULGENCE
SOCIETAL EXAGGERATED
RESPONSIBILITY CONCERN FOR
CARING APPEARANCE
GUIDANCE OF AND
OTHERS POSSESSIONS
LACK OF
INTEREST IN THE
WELFARE OF
OTHERS
INTEGRITY VS. FEELING OF SELF SENSE OF
DESPAIR ACCEPTANCE HELPLESSNESS,
(65 YEARS TO SENSE OF HOPELESSNESS,
DEATH) DIGNITY, WORTH WORTHLESSNESS
AND , OR USEFULNESS
IMPORTANCE

ADAPTATION TO REGRESSION
LIFE ACCORDING LONELINESS
TO LIMITATIONS WITHDRAWAL
VALUING ONE’S AND FOCUSING
LIFE ON PAST
MISTAKES,
FAILURE AND
DISSATISFACTION
S
LACK OF
INVOLVEMENT IN
COMMUNITY OR
PROFESSIONAL
ACTIVITIES OR
ORGANIZATION
LOSS OF
INTEREST IN
MARRIAGE
EXTRA MARITAL
AFFAIR OR BOTH
OR TOO MANY
PROFESSIONAL/
COMMUNITY
ACTIVITIES
DETRIMENT OF
FAMILY
TOO LITTLE TIME
FOR SELF
1. ALLOW THE CHILD TO PARTICIPATE ACTIVELY
IN MAKING DECISIONS AND SOLVING
PROBLEMS THAT AFFECT SELF & THE FAMILY
IN DAILY LIFE IN THE HOME.
2. SINCE THE SCHOOL- AGE CHILD CAN ONLY
PROBLEM- SOLVE WITH CONCRETE
OBSERVABLE ITEMS, LEARNING IS ACHIEVED
BEST BY DOING AND FROM
DEMONSTRATIONS LEARNING BY
EXPERIMENT AND EXPLANATION IS
PREFERRABLE BECAUSE THE CHILD IS
MAKING DISCOVERIES FOR SELF.
IV. PERIOD OF OPERATIONAL
THOUGHT (11 YEARS & )
THE ADOLESCENT IS CAPABLE OF
BOTH HYPOTHETICAL AND
DEDUCTIVE AND LOGICAL
REASONING. HE CAN THINK ABOUT
THE FUTURE.
HE SEES HIMSELF AS WQUAL TO HIS
ELDERS BUT DIFFERENT.
 HE WANTS TO CORRECT SOCIETY’S
ERRORS AND IS FILLED WITH GENEROUS
AND ALTRUISTIC PROJECTS.
 ALTHOUGH THE CHILD IS CAPABLE OF
ABSTRACT THOUGHT, HOWEVER HIS
EMOTIONAL STATE AND LACK OF
PRACTICAL EXPERIENCE CAUSE HIS
JUDGMENT TO BE HARSH.
 DEVELOPMENTAL TASKS- PARENTS MUST
NOW REBUILD THEIR OWN LIVES AND
BECOME MORE INDEPENDENT OF THEIR
CHILD.
 HIS THOUGHTS ARE MORE FLEXIBLE,
RATIONAL AND SYSTEMATIC.
 THE INDIVIDUAL CAN NOW CONCEIVE
ALL THE POSSIBLE WAYS A PROBLEM
MIGHT BE SOLVED AND CAN LOOK AT A
PROBLEM FROM SEVERED POINTS OF
VIEW.
 CHARACTERIZED BY LOGICAL
CONSISTENT APPROACH AND
PROBLEM- SOLVING AND DECISION
MAKING.
 ABLE TO COMPARE AND CONTRAST
VARIABLES AND TRY OUT A VARIETY OF
SOLUTIONS IN HIS MIND WITHOUT
HAVING TO EXPERIENCE AND
MANIPULATE MATERIALS.
 THE ADOLESCENT EXTEND HIS OR HER
THOUGHT TOWARD POSSIBILITIES,
MAKING REALITY A SECONDARY
CONCERN. HE OR SHE OPERATES IN THE
REALM OF “WHAT MIGHT BE”, :WHAT
IF” AND “SUPPOSE THAT” RATHER
THAN ONLY OF WHAT IS.
 BECAUSE OF IDEALISM THE
ADDOLESCENT BEGINS WITH AN
IDEALIZED SELF- IMAGE. THROUGH
ADOLESCENT EXPERIENCE MANY OF
WHICH ARE PAINFUL, HE OR SHE
BECOMES MORE REALISTIC IN SELF
THEORY.
INTELLIGENCE => INDIVIDUAL’S ABILITY
TO COPE WITH THE CHANGING WORLD
THROUGH CONTINUOUS
ORGANIZATION & REORGANIZATION OF
EXPERIENCE.
ADAPTATION => IS CONTINUOUS
PROCESS OF USING THE
ENVIRONMENT TO LEARN &
LEARNING TO ADJUST TO CHANGES
IN THE ENVIRONMENT.
IT IS THE COGNITIVE STRIVING OF
ORGANISMS- THINKING PERSONS-
TO BALANCE THEIR PERSONAL
EXPERIENCE WITHIN THE CONTEXT
OF THE ENVIRONMENT, AS IT
IMPACTS UPON THEM.
PROCESSES:
1. ASSIMILATION => IS THE PROCESS OF
TAKING IN NEW INFORMATION &
FITTING IT INTO PRECONCEIVED
NOTION ABOUT OBJECTS OR THE
WORLD (MAKING THE UNFAMILIAR
SEEM FAMILIAR)
o IT IS A MENTAL PROCESS OF
EXPERIENCING ON EVENT IN TERMS
OF PAST (INTERNAL) EXPERIENCE. IN
SHORT, IT IS UNDERSTANDING THE
NEW BY WHAT IS ALREADY KNOWN.
2. ACCOMODATION => MEANS ADJUSTING TO
NEW EXPERIENCES OR OBJECTS BY REVISING
THE OLD PLAN TO FIT THE NEW
INFORMATION.
o IT INVOLVES THE IMPACT OF THE
ENVIRONMENT UPON THE INDIVIDUAL TO
ACCOMMODATE IS TO ADJUST, TO CHANGE
AN EARLIER CONCEPTION INTO THE
DEMANDS OF THE ACTUAL EVENT.
o PROCESS OF REACHING OUT, RESPONDING
TO THE REQUIREMENTS OF THE
ENVIRONMENT & ALLOWING NEW WAYS OF
THINKING TO OCCUR.
SCHEMA => IS A SIMPLE MENTAL IMAGE
OR PATTERN OF ACTION, A FORM OF
ORGANIZING INFORMATION WHICH A
PERSON USES TO INTERPRET THE
THINGS HE SEES, HEARS, SMELLS &
TOUCHES.
EGOCENTRISM => PIAGET DOES NOT
MEAN SELFISHNESS- A CHILD SIMPLY
BELIEVES THAT EVERYONE SEES THE
WORLD IN EXACTLY THE SAME WAY HE
DOES.
EXAMPLE FOR SCHEMA, ASSIMILATION &
ACCOMODATION:
 THE REMEMBRANCE OF A SMELL CAN
BRING BACK THE IMAGE OF THE OBJECT
ASSOCIATED WITH THE SMELL, SUCH AS
A CUP OF COCOA OR FRESHLY BAKED
BREAD. THE CHILD WHO RIDES HIS OWN
BICYCLE CAN TRANSFER THIS ACTION TO
RIDE ANY BICYCLE BECAUSE HIS
SCHEMA OF BIKE- RIDING INVOLVES A
SPECIFIC PATTERN OF MUSCLE
MOVEMENT &BALANCE.
 “DOG” CAN CONJURE A SCHEMA OF A FOUR-
FOOTED BARKING ANIMAL.
 FOR A SMALL CHILD, SOME OBJECTS CAN BE
EASILY BENT USING THIS SCHEMA. HE
EXPERIMENTS WITH CRACKERS AFTER
REPEATD ATTEMPS TO BEND THE CRACKERS
(ASSIMILATION), HE FINDS THEY CAN’T BE
BENT- THEY ONLY BREAK. THE CHILD MUST
REVISE HIS FORMER WAY OF THINKING ABOUT
CRACKERS & DEVELOP A NEW SCHEMA OR
WANTED IMAGE CONCERNING THEM
(ACCOMODATION). HIS NEW SCHEMA
 IS THAT CRACKERS DO NOT BEND. THIS
SCHEMA HAS ADDED TO HIS KNOWLEDGE
ABOUT THE WORLD & WHEN CONFONTED
WITH SIMILAR SITUATIONS- COOKIES,
CRACKERS & OTHER BREAKABLE MATERIALS
HE WILL NOT BE ABLE TO BEND THEM.

 THE INFANT WHO TRIES TO DRINK MILK FROM

HIS RATTLE (ASSIMILATION) SOON LEARNS
THAT RATTLES ONLY MAKE NOISE. THE RATTLE
IS NO LONGER A SUBSTITUTE FOR FEEDING
(ACCOMODATION).
KNOWLEDGE OF INTELLECTUAL DEVELOPMENT
& INTELLECTUAL NEEDS OF CHILDREN AT
VARIOUS AGES IS EXTREMELY VALUABLE TO
THE NURSE:
1. IT HELPS THE NURSE TO MORE
MEANINGFULLY DECIPHER A CHILD’S
COMMUNICATION.
2. HELPS THE NURSE TO MORE ACCURATELY
INTERPRET HIS BEHAVIORS & THE
PROCESSES THAT MOTIVATE THEM & TO
REALIZE MORE EMPATHETICALLY THE
MEANING OF VARIOUS EXPERIENCES HAVE
FOR THE CHILD.
 STAGE OF AGE SPAN NURSING
DEVELOPMENT IMPLICATIONS

1. SENSORIMOTOR

A. NEONATAL 1 MONTH STIMULI ASSIMILATED

REFLEXES INTO BEGINNING
MENTAL IMAGES
BEHAVIOR ENTIRELY
REFLEXIVE.
B. PRIMARY CIRCULAR 1-4 MONTHS HAND- MOUTH & EYE-
REACTION EAR COORDINATION
DEVELOP. INFANTS
SPEND MUCH TIME
LOOKING AT OBJECT
AND SEPARATE SELF
FROM THEM
BEGINNING
INTENTIONS OF
BEHAVIOR PRESENT
(INFANT BRINGS
THUMB TO MOUTH FOR
A PURPOSE TO SUCK
IT).
ENJOYABLE ACTIVITY
FOR THIS PERIOD:
RATTLE OR TAPE OR
PARENT’S VOICE
C. SECONDARY 4-8 MONTHS INFANTS LEARN TO
CIRCULAR REACTION INITIATE, RECOGNIZE
AND REPEAT
PLEASURABLE
EXPERIENCES FROM
ENVIRONMENT.
MEMORY TRACES ARE
PRSENT; INFANT
ANTICIPATE FAMILIAR
EVENTS
(A PARENT COMING
NEAR HIM WILL PICK
HIM UP). GOOD TOY
FOR THIS PERIOD:
MIRROR
GOOD GAME: PEEK- A-
BOOS.
D. COORDINATION OF 8-12 MONTHS INFANT CAN PLAN
SECONDARY REACTION ACTIVITIES TO ATTAIN
SPECIFIC GOALS.
PERCEIVES THAT
OTHERS CAN CAUSE
ACTIVITY OF OBJECT.
CAN SEARCH FOR AND
RETRIEVE TOY THAT
DISAPPEARS FROM
VIEW.
RECOGNIZES SHAPES &
SIZES OF FAMILIAR
OBJECTS BECAUSE OF
INCREASED SENSE OF
SEPARATENESS, INFANT
EXPERIENCES
SEPARATION ANXIETY
WHEN PRIMARY CARE
GIVER LEAVES HIM.
GOOD TOY FOR THIS
PERIOD: NESTING
TOYS, i.e. COLORED
BOXES
E. TERTIARY CIRCULAR 12-18 MONTHS CHILD IS ABLE TO
REACTION EXPERIMENT TO
DISCOVER NEW
PROPERTIES OR
OBJECTS AND EVENTS.
CAPABLE OF SPACE
PERCEPTION & TIME
AS WELL AS
PERMANENCE.
OBJECTS OUTSIDE SELF
ARE UNDERSTOOD AS
CAUSES OF ACTIONS.
GOOD GAME FOR THIS
PERIOD: THROW &
RETRIEVE.
F. INVENTIONS OF NEW 8-12 MONTHS INFANT CAN PLAN
MEANS THROUGH ACTIVITIES TO ATTAIN
MENTAL SPECIFIC GOALS.
COMBINATIONS PERCEIVES THAT
OTHERS CAN CAUSE
ACTIVITY OF OBJECT.
CAN SEARCH FOR AND
RETRIEVE TOY THAT
DISAPPEARS FROM
VIEW. RECOGNIZES
SHAPES & SIZES OF
FAMILIAR OBJECTS
BECAUSE OF INCREASED
SENSE OF
SEPARATENESS, INFANT
EXPERIENCES
SEPARATION ANXIETY
WHEN PRIMARY CARE
GIVER LEAVES HIM.
GOOD TOY FOR THIS
PERIOD: NESTING TOYS,
i.e. COLORED BOXES
2. PRE-OPERATIONAL 2-7 YEARS THOUGHTS BECOME
THOUGHT MORE SYMBOLIC
CHILD CAN ARRIVE
AN ANSWER
MENTALLY INSTEAD
THROUGH PHYSICAL
ATTEMPT ONLY.
COMPREHENDS
SIMPLE ABSTRACTIONS
CUT THINKING IS
BASICALLY CONCRETE
AND LITERAL.
CHILD IS
EGOCENTRIC (UNABLE
TO SEE VIEW POINTS
OF OTHERS)
STATIC THINKING (
INABILITY TO
REMEMBER WHAT HE
STARTED TO TALK
ABOUT, SO THAT AT END
OF A SENTENCE HE
MAYBE TALKING ABOUT
ANOTHER TOPIC).
CONCEPTS OF TIME,
NOW CONCEPT OF
DISTANCE ONLY AS FAR
AS HE CAN SEE.
CENTERING OR
FOCUSING ON SINGLE
ASPECTS OF AN OBJECT
CAUSES DISTORTED
REASONING.
NO AWARENESS OF
REVERSIBILITY (THAT
FOR EVERY ACTION
THERE IS AN OPPOSITE
ACTION).
3. CONCRETE 7-12 YEARS CONCRETE
OPERATIONAL OPERATIONS INCLUDE
THOUGHT SYSTEMATIC
REASONING.
CHILD USES
MEMORY TO LEARN
BROAD CONCEPTS
(FRUIT AND
INDIVIDUAL ASPECTS
OF CONCEPTS: APPLES,
ORANGES)
CLASSIFICATIONS
INVOLVE: SORTING
OBJECTS ACCORDING
TO ATTRIBUTES SUCH
AS: COLOR
SERIATION,IN WHICH
OBJECTS ARE ORDERED
ACCORDING TO
INCREASING OR
DECREASING.
CLASSIFICATIONS
INVOLVE: SORTING
OBJECTS ACCORDING
TO ATTRIBUTES SUCH
AS: COLOR
SERIATION,IN WHICH
OBJECTS ARE ORDERED
ACCORDING TO
INCREASING OR
DECREASING.
UNDERSTANDS
CONVERSATIONS,SEES
CONSTANCY INSPITE
OF TRANSFORMATION
(MASS OR QUANTITY
REMAINS SAME EVEN
IF IT CHANGES
SHAPEOR POSITION).
GOOD ACTIVITY FOR
THIS PERIOD:
COLLECTING AND
CLASSIFYING NATURAL
OBJECTS SUCH AS
NATIVE PLANTS, SEA
SHELLS, ETC.
MEASURES SUCH AS
WEIGHT;
MULTIPLICATIONS, IN
WHICH OBJECTS ARE
SIMULTANEOUSLY
CLASSIFIED AND
SERIATED USING
WEIGHT.
CHILD IS AWARE OF
REVERSIBILITY, AN
OPPOSITE OPERATION
OR CONTINUATION OF
REASONING BACK TO A
STARTING POINT
(FOLLOWS ROUTE
THROUGH MAZE AND
THEN REVERSES
STEPS). EXPOSE CHILD
TO OTHER
VIEWPOINTS BY
ASKING QUESTINS
SUCH AS, “HOW DO
YOU FEEL IF YOU WERE
A NURSE AND HAD TO
TELL A BOY TO STAY IN
BED?”
 4. FORMAL 12 YEARS CAN SOLVE
OPERATIONAL HYPOTHETICAL
THOUGHT PROBLEMS WITH
SCIENTIFIC
REASONING;
UNDERSTANDS
CASUALITY & CAN
DEAL WITH PAST,
PRESENT AND FUTURE
ADULT OR MATURE
THOUGHTS.
GOOD ACTIVITY:
“TALK TIME” TO SORT
ATTITUDES AND
OPINIONS.