Health Assessment

Assessing
Psychosocial,
Cognitive, and
Moral Development
Huesca, Sheryn Mae
Josen, Rased
 Health Assessment

An overview of the developmental concepts of

Sigmund Freud (1856–1939), Erik Erikson (1902–
1994), Jean Piaget (1896–1980) and Lawrence
Kohlberg (1927–1987) will be presented in this
chapter. Having a basic understanding of the
significant contributions made by these
theorists of the psychosexual, psychosocial,
cognitive, and moral development of humans is
fundamental to performing a holistic nursing
assessment.
 Health Assessment

Growth and Development

There is no single theory that encompasses all aspects of why
humans behave, think, or believe the way they do. New hypotheses
are constantly emerging in an attempt to explain human behavior.
The developmental theories discussed in this chapter are
concerned with an individual's growth (addition of new abilities or
components) and development (refinement, extension, or
enhancement of existing skills or components) during the course of
his or her life. The phases of the life cycle are classified differently
by each theorist (e.g., infancy, adolescence, adulthood).
 FREUD’S THEORY OF PSYCHOSEXUAL
DEVELOPMENT

Sigmund Freud (1935), a Viennese physician,

developed the first formal theory of personality. He
originated the concept of psychoanalysis and that
believed personality development was based on
understanding the individual life history of a
person.

Sigmund Freud
Freud’s Major Concepts and Terms

Freud (1935) postulated that the psychological nature of

human beings is determined by the result of conflict
between biologic drives (instincts) and social expectations.
He believed that people generally are not aware of the
underlying reasons for their behavior. Originally, Freud
conceived the concept of mental qualities, which influence
behavior and occur at three levels of awareness.
The first level, consciousness, refers to whatever a person is
sensing, thinking about, or experiencing at any given moment. Freud
considered this level to be limited, since only a small amount of such
thought exists at one time.

The second level, preconsciousness, involves all of a person’s

memories and stored knowledge that can be recalled and brought to
the conscious level. Freud declared the third level, unconsciousness,
as the largest and most influential. This level corresponds to socially
unacceptable sexual desires, shameful impulses, irrational wishes, as
well as anxieties and fears.
Later, Freud revised his theory to include three basic structures in his
anatomy of the personality: the id, ego, and superego (Freud, 1949).
He believed these structures could operate within any of the levels of
awareness; however, he declared the id to be completely
unconscious. According to Freud, the id is the inherited system.
Containing the basic motivational drives for such entities as air, water,
warmth, and sex, it seeks instant gratification and supplies the
psychic energy for the ego and the superego.
Freud’s Stages of Psychosexual
Development

In his 1935 work, Sigmund Freud described how he developed

his psychoanalysis as he listened to and attempted to direct
the thoughts of his adult patients who presented with a
variety of symptoms (such as paranoia, phobia or paralysis)
that appeared to have no physical basis. He became
convinced that their symptoms could be relieved by
encouraging them to talk with him about painful events from
early childhood.
 Erikson Theory of Psychosocial
Development
Erik Erikson was a psychoanalyst who adapted and expanded
Sigmund Freud's (1935) psychosexual theory. Erikson's theory has
become known as a psychosocial theory, with psychosocial being
defined as the intrapersonal and interpersonal responses of a
person to external events (Schuster and Ashburn, 1992).

Erikson concluded that societal, cultural, and historical factors as

well as biophysical processes and cognitive function influence
personality development (Erikson, 1968). He declared that the ego
not only mediated between the id’s abrupt impulses and the
superego’s moral demands, but that it can positively affect a
person’s development as more skills and experience are gained.
Unlike Freud, Erikson believed that personality development
continues to evolve throughout the life span. Whereas Freud
Erik Erikson attempted to explain reasons for pathology, Erikson searched for
foundations of healthy personality development.
Erikson’s Major Concepts
and Terms
Erikson is best known for identifying eight stages of the life span through
which a person may sequentially develop (Table 7-2). In his 1963 and 1968
works, Erikson proposed that each stage (or achievement level) has a
central developmental task corresponding to both biophysical maturity and
societal expectations. He called these tasks crises, dilemmas that are
composed of opposing viewpoints. Positive resolution for a crisis in one
stage is necessary for positive resolution in the next stage. In addition,
Erikson proposed basic virtues (vital strengths) that emerge with the
positive resolution of each crisis. These outcomes are animating life forces
that need to be reaffirmed continuously throughout one’s lifespan
 Erikson’s Stages of Psychosocial
Development
Erikson did not strictly define chronological boundaries for his stages. He did
assign selected developmental levels throughout the life span termed critical
periods, as times when a person possesses criteria to attempt a given
developmental task (Erikson, 1963). Each person develops at his or her own
rate in accordance with individual potential and experience.

Erikson used several techniques to form his theory, including therapy analysis
of people with emotional disturbances as well as observations of people who
were assessed to have healthy psychosocial development. He performed
anthropologic studies of Native Americans and psychohistorical analyses of
figures who have profoundly influenced mankind.
 PIAGET’S THEORY OF COGNITIVE
DEVELOPMENT

Dr. Jean Piaget (1970) described himself as a genetic

epistemologist (one who studies the origins of knowledge). His
theory is a description and an explanation of the growth and
development of intellectual structures. He focused on how a
person learns, not what the person learns.

Cognition is the process of obtaining understanding about

one’s world (Schuster & Ashburn, 1992). Piaget acknowledged
that interrelationships of physical maturity, social interaction,
environmental stimulation, and experience in general were
necessary for cognition to occur (Piaget & Inhelder, 1969). His
primary focus, however, was the biology of thinking.

Dr. Jean Piaget

Piaget’s Major Concepts and Terms

Piaget believed that individual cognitive development occurred as the result of

one’s organization and adaptation to the perceived environment. To explain his
theory, he applied the concepts of schema (plural: schemata), assimilation,
accommodation, and equilibration (equilibrium). A schema is a unit of thought
and a classification for a phenomenon, behavior, or event. A schema may consist
of a thought, emotional memory, movement of a part of the body, or a sensory
experience (such as making use of sight, hearing, taste, smell, or touch).
Schemata can be categorized using either assimilation or accommodation.
Piaget’s Stages of Cognitive
Development

Piaget (1970) postulated that a person may progress through

four major stages of intellectual development. He theorized that
intellectual development begins the moment a baby is born. He
did not believe that absolute ages should be attached to these
stages since individuals progress attheir own rate.
 KOHLBERG’S THEORY OF MORAL
DEVELOPMENT

Lawrence Kohlberg, a psychologist, expanded Piaget’s

thoughts on morality; in doing so, he developed a
comprehensive theory of moral development.
Traditionally, Kohlberg (1981) proposed, individual
morality has been viewed as a dynamic process that
extends over one’s lifetime, primarily involving the
affective and cognitive domains in determining what is
“right” and “wrong.”

Dr. Jean Piaget

Kohlberg’s Major Concepts and
Terms
Kohlberg recognized that moral development is influenced by cognitive
structures. However, he did not view moral development as parallel to
cognitive development. In his later years, he discussed how some components
of his theory contained elements of affective or reflective characteristics of
people and proclaimed these to be soft stages. Those stages that contained
only the Piagetian structures were differentiated as hard stage (Levine,
Kohlberg, & Hewer, 1985).

Kohlberg viewed justice (or fairness) as the goal of moral judgment. He often
cowrote with colleagues, publishing new thoughts regarding the form and
content of his theory. This included the addition of several substages to his
existing proposed stages of moral development.
Kohlberg’s Stages of Moral
Development
Kohlberg (Colby, Kohlberg, Gibbs, & Lieberman, 1983) proposed three
levels of moral development, best recognized as encompassing six
stages.

Kohlberg assumed that a person must enter the moral stage hierarchy in
an ordered and irreversible sequence. No guarantee was made that a
person enters a stage based on biologic age.

Kohlberg did not theorize that infants and young toddlers were capable of
moral reasoning. He viewed them as being naïve and egocentric.
Pair Reporting

THANK YOU!

Huesca, Sheryn Mae

Josen, Rased