UNIT 4 DEVELOPMENTAL STAGES OF

AN INDIVIDUAL
Structure
4.0 Objectives
4.1 Introduction
4.2 Definitions of Terms
4.3 Theories of Development
4.3.1 Freud’s Psychoanalytic Theory : Development of Sexuality
4.3.2 Erickson’s Theory of Psychosocial Development
4.3.3 Sullivan’s Interpersonal Theory of Development
4.4 Factors affecting Growth and Development
4.4.1 Heredity
4.4.2 Environment
4.4.3 Self
4.5 Needs, Problems and Tasks of Various Developmental Stages
4.5.1 Infant
4.5.2 Toddler
4.5.3 Preschooler
4.5.4 School Age Child
4.5.5 Adolescents
4.5.6 Adulthood and Middle Age
4.5.7 Old age
4.6 Death and Dying
4.7 Let Us Sum Up
4.8 Answers to Check Your Progress

4.0 OBJECTIVES
After going through this unit, you will be able to:

define development, growth and maturation;

explain the various theories of development;

explain the factors affecting development;

describe the different stages of development of an individual;

identify the needs, problems and tasks of various developmental stages; and

enumerate emotional stages associated with process of dying.

4.1 INTRODUCTION
Human growth and development is an orderly, predictable process beginning with
conception and continues until death. It involves many complex changes in all dimensions
of a person through the life span. Each person progresses through definite phases of growth
and development, but the pace and progression of this development are highly individual.
Heredity and environment influence the growth and development of an individual.
Environment refers to both psychosocial and physical influences. Nurses must incorporate
developmental perspective in nursing care to effectively assess the client’s needs and
provide comprehensive care to the client. This unit discusses the important theories of
growth and development; and you will also learn the needs, problems and tasks of each, 81
Concepts in Nursing developmental stage of human life. It will also enlighten you on the importance of learning
developmental stages. The concepts of health nursing and nursing theories which you have
studied in the previous chapters, will help you in understanding the developmental stages
of an individual and thus meeting various needs of an individual in holistic manner.

4.2 DEFINITIONS OF TERMS

Growth and development are not synonymous terms but they are interdependent in
function.

Growth

Growth refers to an increase in physical size of the whole or any parts and can be measured
in inches or centemeters and pounds or kilograms. “(Marlow and Redding, 1998, p.163).
Therefore, growth is a change in quantity and occurs when cells divide and cells increase in
number and size due to synthesis of protein.

Development

Development refers to progressive increase in skill and capacity to function which causes
qualitative change from a lower to a more advanced stage of complexity. Development is
orderly and is reasonably enduring. The development also refers to intellectual, moral,
emotional, sexual, social, language, speech, and spiritual developments.

Development Task

Development task is defined as a set of skills and competencies peculiar to each stage of
development that must be accomplished by the children to deal effectively with their
environment.

Maturation

Maturation is the process of becoming fully developed and grown. It literally means to
ripen and involves qualitative change in individual’s biological dimension, alterations in
function at a higher level and further it depends on the child’s heredity, (Marlow and
Redding, 1989).

In the first 20 years of life, developmental changes result in new, improved ways of
behaviour that is healthier, more organized, more complex, more stable and more
competent.

Personality

Personality refers to the whole group of adjustment techniques and equipments that are
characteristics for a given individual in meeting the various situations of life. It is the
aggregate of the physical and mental qualities of the individual as these interact in
characteristic fashion with its environment. Personality distinguishes one individual from
another.

4.3 THEORIES OF DEVELOPMENT

Since the beginning of twentieth century, research into human growth and development has
led to a number of different developmental theories. Different theories emphasize on
different aspects of development. Some theories view development as a continuous
process, other consider it as a discontinuous, with alternating periods of relative
equilibrium and disequilibrium. Not one theory cover all developmental areas of interest to
nurse, so the knowledge of various theories is essential for providing comphrehensive care
to the patients.

Some of the theories discussed are:

4.3.1 Freud’s Psychoanalytic Theory: Development of Sexuality

Freud’s theory of personality development describes three major categories:
82
1) The Structure of Personality: It consists of id, ego and superego. Id is the
 unconscious reservoir of primitive drives and instincts which looks for immediate Developmental Stages
gratification of needs. Ego meets and interacts with the outside world as a mediator of an Individual
and is the executive function of personality. It operates at all three levels of
consciousness. Superego acts as the censoring force or conscience of the personality.
It is composed of morals; values and ethics largely derived form one’s parents.
Superego also operates at all three levels of consciousness.

2) Dynamic of Personality: Each person has a certain amount of psychic energy to cope
with the problems of everyday living. Person’s behaviour is governed by the psychic
energy of id, ego and superego.

3) The development of personality: Freud explains it by describing three levels of

consciousness: the unconscious, preconscious and conscious. The unconscious level
consists of drives, feelings, ideas and urges which a person is not aware of, the
preconscious level consists of feelings, ideals, drives and ideas that are out of one’s
ongoing awareness but can be recalled readily. The conscious level of personality
refers to the awareness of the present.

Freud also described five phases of psychosexual development that have a great impact
upon personality development: these are oral, anal, phallic, latency and genital phase. Table
4.1 describes the various developmental stages and tasks to be accomplished in each stage.

Table 4.1: Freud’s Psychosexual Developmental Stages

Stage Task
Oral Phase Pleasure derived mainly through the mouth by the actions of sucking or
0-18 months biting; learns to differentiate between self and mother; body image
(Infancy) develops. Lasting virtues are drive and hope. Significant persons are
mother or substitute.
Anal Phase Toilet training is the critical experience, attention focuses on the excretory
18 months-3 years function. Foundation is laid for the development of super ego. Lasting
(Toddler) virtues are self control and will power; significant persons are parents.
Phallic Phase Child begins questioning ; Child develops a sexual identity of male or
2-6 years female role; identifies with the parent of the same sex, forms a deep
(Preschool) attachment to the parent of the opposite sex; explore own body and
environment; begins to experience guilt. Lasting virtues are purpose and
direction, significant persons are basic family.
Latency Phase The person relates to own sex; learns to win recognition by creating of
7 yrs-adolescence producing things, develops an inner control over aggressive and
destructive impulses; experiences intellectual and socially lasting virtues,
develops competencies. Significant persons are from the neighbourhood
and school.
12 yrs-early Child moves towards hetrosexuality; begins to separate from family;
adolescence puberty selects vocation. Lasting virtues are deviation fidelity. Significant persons
are peer groups and models of leadership.
Genital Phase The person develops the capacity for object love and mature
adolescence and heterosexuality. Identity and independence are established. Learning to be
Young adult creative. Lasting virtues are affiliation and love: Significant persons are
friends, sexual partners, besides members with whom they cooperate and
compete.

The needs of each stage should be understood by the nurse. so to help the individuals and
families to meet the needs. The condition when one does not develop from one stage to
next and is not satisfied to proceed to the next stage is called fixation.

Freud’s theory of development has several limitations:

1) It does not include all ages.

2) Heavy emphasis is placed on physical and sexual development.
3) Limited attention is given to cognitive and moral development.

This theory cannot be easily applied to normal behaviour, since it is based on data gathered
on pathological behaviour. Despite limitations Freud’s theory of development is helpful in 83
Concepts in Nursing highlighting the importance of certain life experiences and early interactions that may have
significant impact on later development.

4.3.2 Erikson’s Theory of Psychosocial Development (Erik Erikson)

Erikson described emotional or personality development as a continuous process with
distinct stages. Each stage is characterized by the achievement of a particular
developmental goal and developmental task to be mastered. Success in mastering the task
prepares an individual to progress to the next stage. Inability to master a developmental
task results in frustration and difficulty in coping with subsequent stages. Proper guidance
is necessary at each stage of development to secure functional harmony in adult life.

Erikson has identified eight psychosocial stages during one’s life. These developmental
stages are a series of normative conflicts that every person must handle. The two opposing
energies must be synthesized in a constructive manner to produce positive expectations for
new experiences. Table 4.2 presents the Erikson’s stages of psychosocial development and
the tasks to be accomplished in each phase.
Table 4.2 : Erikson’s Psychosocial Developmental Stages

Stage of development Developmental task

Oral sensory (0-2 yrs)
Anal (2-4 yrs)
Genital-locomotion (4-8 yrs)
Latency (8-12 yrs)
Puberty and adolescence (13-20 yrs)
Young adulthood (20-30 yrs)
Middle adulthood (30-60 yrs)
Maturity or late adulthood
(65 yrs-Death)
Trust Vs Mistrust
Autonomy Vs Share and doubt
Initiative Vs Guilt
Industry Vs Inferiority
Identity Vs Role confusion
Intimacy Vs Isolation and Solidarity
Generativity Vs Self absorption and Stagnation
Integrity Vs despair

Erikson’s theory of development emphasizes growth and development and conflict as an

ongoing process. This is a realistic approach, since an individual’s thoughts, feelings and
environment are seldom the same at all times. A person’s ability to change and adopt
behaviour is important in maintaning control over his life. This theory emphasizes both
what a person is attempting to achieve at a given time and what he wishes to avoid. These
are mainly two limitations of Erikson’s theory. Firstly, the age ranges for each stage are
large, making it difficult to assign the completion of a task to a certain age. Secondly, the
task of one stage may overlap the next stage.

4.3.3 Sullivan’s Interpersonal Theory of Development

Sullivan has described six stages of personality development from birth to maturity, which
he has divided according to the capacity for communication, and integration of new
interpersonal experiences. The personality achieves some degree of stability at the end of
juvenile era, but continues to develop beyond their time and has potential for corrective
experiences. Sullivan believed that the juvenile and per-adolescent eras contain the greatest
opportunity for corrective experiences.

4.4 FACTORS AFFECTING GROWTH AND

DEVELOPMENT
4.4.1 Heredity
Each type of living thing transmits specific hereditary information from one generation to
the next. Inheritance influences the development of some traits more than others due to
genetic constitution. It not only influences physical features but also influences primary
reaction tendencies e.g. activity level, sensitivity to stimuli etc. The rate of growth is more
alike among siblings than among unrelated persons.
84 Essential characteristics of human inheritance are basically same for all but specific
features differ. So heredity provides with similarity in human beings as well as individual Developmental Stages
differences. Examples of conditions are : thalassemia. of an Individual

4.4.2 Environment
Along with genetic inheritance we also acquire social inheritance. Whatever values a
particular society has or the rules that are set up the individuals brought up in that society
will pick up the same rules and will have the same values. Subgroups within a general
socio-cultural environment such as family, sex, age, social class, occupational and religious
group also foster beliefs and norms of their own, largely by means of social roles that their
members learn to adopt. Role expectations also influence development. If individual’s
social roles are conflicting, unclear and uncomfortable or he is unable to achieve
satisfactory role in the group, personality development and adjustment is impaired. Our
genetic provides our potentialities for both biological and psychosocial development, but
shaping of those potentialities in terms of perceiving, thinking, feeling and acting depends
heavily on our physical and socio-cultural environment.

4.4.3 Self
As an infant grows s/he learns to distinguish between himself/herself and other people and
think– ‘me’, ‘I’, ‘self’. As this self-structure develops, it becomes the integrating core of
the personality. When a problem comes it is thought about and acted upon in relation to the
self. The experience of self-direction involves the self as knower, striver and doer which
are three key functions of self-structure. The self includes the total subjective and objective
qualities of a person. It includes the person’s actual appearance, values, ideas and
knowledge as well as self-perception and the perceptions of others.

Check Your Progress 1

1) Define the following terms:

a) Development
............................................................................................................................
............................................................................................................................
b) Growth
............................................................................................................................
............................................................................................................................
c) Personality
............................................................................................................................
............................................................................................................................
2) List down the five stages of Psychosexual development (Freud’s psychoanalytic
theory).
a) ............................................................................................................................
b) ............................................................................................................................
c) ............................................................................................................................
d) ............................................................................................................................
e) ............................................................................................................................

3) What are the factors that affect growth and development.

...................................................................................................................................
...................................................................................................................................
...................................................................................................................................

4.5 NEEDS, PROBLEMS AND TASKS OF VARIOUS

DEVELOPMENTAL STAGES
From the moment of conception, human development proceeds at a rapid rate. During the
prenatal period, the embryo grows from a single cell to a zygote, a complex, psychological 85
Concepts in Nursing being. All major systems develop in utero and some start functioning before birth. The
psychosocial aspects also begins to emerge during the gestation period. Most intrauterine
health problems are caused by a combination of genetic and environmental factors.
Successful attainment of developmental tasks leads to healthy self image and success with
later tasks. Failure to achieve developmental taks at one stage leads to unhappiness in the
individual, disapproval of society and difficulty in accomplishing late developmental tasks.

4.5.1 Infant
Infancy is the period from birth to 1 year of age. The infants ability to handle the body, to
learn and interact with environment develops dramatically. The first 28 days of life is the
neonatal period. During this stage the newborn’s physical functioning is mostly reflexive
and stabilization of major organ system is the body’s primary task. For example, the
newborn’s cry is generally a reflexive response to the unmet need, such as, hunger. Nurses
can apply knowledge of growth and development at this stage to assist the parents to
identify the ways to meet needs of a neonate. Infancy is characterized by rapid physical
growth and change. Interaction between the infant and environment is greater and more
meaningful.

a) Physical Development

Steady and proportional growth of the infant is important. Growth charts help the nurse to
evaluate growth pattern by recording measurements of weight, length and head
circumference, chest circumference at intervals. It is the best way to monitor growth and
identify problems. Infants usually double their birth weight by 6 months and it triples it by
12 months. They grow 10 to 12 inches at the end of their first year. The quantity and
quality of nutrition influences the infant’s growth and development. During the first 6
months of age exclusive breast-feeding is recommended for the infants.

b) Physiological Stability

Infant struggles for physiological stability in the first few months after birth. Their
breathing is shallow, rapid and irregular. Keeping the baby warm, giving him a feeling of
support, holding him closely, protecting him from strong sensory stimuli such as loud
noise, external heat or cold, helps infant during transition period. Cuddling, bathing,
feeding and other details of daily care helps to establish regularity of breathing, feeding and
circulatory pattern. Physical growth, emotional, social and neuromuscular learning are
concurrent, interrelated, and rapid in the first year.

c) Psychosocial Development

i) The intellectual, emotional, social and moral components can be combined into what
is often referred to as psychosocial development. The separation of these facets of
growth is artificial for they are closely interrelated. Similarly, psychosical, physical,
and motor development greatly influence each other.

The infant learns much by experiencing and manipulating the environment. During
infancy, intellectual growth is more dramatic than any other development period.
Development of motor, visual and auditory skills enhances cognitive development.
Cognitive behaviour includes thinking, perceiving, remembering, forming concepts,
cognitive development in learning.

One-month-old infant can visually follow the path of a moving object. Improved
visual activity and eye-head coordination allow grasping and exploration of objects.
The infant’s hearing also progresses. He is able to localize and discriminate the
sounds. By one year the infant knows the meaning of different sounds. Speech also
develops during infancy. By 12 months the infant begins to recognize objects in the
environment. Nurses must understand that the hospitalized infants need adequate
stimulation for proper intellectual growth. Visual, sensory and tactile stimulations are
as necessary for healthy development as food.

ii) Development Tasks in infancy

1) Achieve physiological equilibrium after birth

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2) Establish self as a dependent person but separte from others Developmental Stages
of an Individual
3) Become aware of the environment, e.g., live versus inanimate, familiar versus
unfamiliar and develop rudimentary social interaction
4) Develop a feeling of and desire for affection and response from others
5) Learn new motor skills; begin eye-hand coordination and establish rest-activity
rhythm
6) Start developing preverbal communication, e.g., by 9 to 12 months the infant
recognises his/her own name, responds to the word ‘no’ and begins to use articulate
sounds to convey meaning to others
7) Direct emotional expression to indicate needs and wishes.

4.5.2 Toddler
i) Needs

The Toddler period ranges from the first to the third year of life. Toddlerhood is
characterized by increasing independence due to greater physical mobility and cognitive
abilities. The toddler is pleased with successful efforts with his new skills. He attempts to
control his environment. Unsuccessful attempt to control may result in negative behaviour
and temper tantrums.

Physical Development

The child walks in an upright position. Gross motor skills develop rapidly, he is able to
wall up and down stairs, kick a ball, jump and stand on one foot. He can ride a tricycle and
can run well. He is able to draw circle and can usually stack a tower of small blocks. He is
able to undress himself and is able to develop sphincter control, which allows toilet
training. The nurse needs to teach parents that patientce; consistency, non-judgmental
attitude and child’s readiness are essential component for toilet training.

The cardiopulmonary system becomes stable. The anterior fontanel closes between 12 and
13 months of age. By 2 years the child weighs four times his birth weight and height
increases 3 to 5 inches a year. Nutritional requirements are increasingly met by solid foods.
The nurses should advise parents to limit milk intake of toddler to 28 ounces per one liter
per day, so that essential solid foods can be served. Small reasonable servings allow the
toddler to eat all his meal.

The toddler’s visual activity and ability to accommodate, to make adjustments to objects at
varying distances from his/her eyes, are comparable to that of an adult. Play is the mode
through which the toddler learns to manage his body, improves muscular coordination and
manual dexterity. He also releases emotional tensions, aggression through play defects.

Psychosocial Development

This stage is characterized by development of autonomy. The child explores his immediate
environment. The toddler is a self-loving, uninhibited, dominating, energetic little person
absorbed in his/her own importance, always seeking attention and approval.

Parents usually remain the most significant persons in toddler’s life. Toddler is extremely
active and unable to limit his own behaviour parents must set limits. This causes conflict
beween the toddler and parents. Firm, consistent limit setting helps to lessen the conflict as
the child grows older and internalizes his behaviour limits. Toddler explores his
environment, which can lead him to open and taste noxious material. Parents must look up
all possible positions to create a safer environment for toddler. The toddler begins to adapt
to his culture because of primary identification. S/He imitates the parents and responds to
their encouragement and discouragement. At this stage the chief molder of personality is
the family unit and the center of the toddler’s world is home.

Cognitive Development

The toddler moves from the sensorimotor to the pre-conceptual stage of cognitive
development. In this the child learns to recognize the premanency of objects, develops a 87
Concepts in Nursing memory of events. Child is ego centric and is unable to assume the view of another. Child
uses languages as a major tool and frequently expresses fantasy and magical thinking.
Toddlers do not understand the concepts of right and wrong. They grap the fact that some
behaviour, brings pleasants results and other elicit unpleasant results. He behaves simply to
avoid unpleasant and seeks out the pleasant. Learning to communicate in an understandable
manner through speech begins during this time. A 24 months old child has a vocabulary of
up to 300 works and speaks short sentences.

ii) Developmental Tasks

Developmental tasks for the toddler may be summarized as follows:

1) Setting into healthy daily routines

2) Mastering eating habits
3) Mastering basic toilet training
4) Developing the physical skills appropriate to his/her age
5) Becoming a family member
6) Learning to communicate efficiently with an increasing number of other members.

4.5.3 Preschooler
i) Needs

This period spans the ages between 3 and 6 years. Preschooler child is less negative and
can more accurately share his thoughts and can more effectively interact and communicate.
Physical development is slow and cognitive and psychosocial development is rapid.

Physical Development

Weight increases approximately 2 of 2½ kg per year and height increases approximately 2

inches per year. Nutritional needs reamain relatively stable. Fine muscle coordination
improves. The preschooler runs well, walks up and down steps with ease and learns to hop.
By 6 years, child skip and throw and catch a ball. He can copy circles, crosses, squares and
triangles. The child needs opportunities to learn and practice physical skills.

Psychosocial Development

Preschooler relies on the support of parents for security. He is less afraid of strangers and
seeks out experiences with peers. He enjoys playing with peers. He has the tendency to
explore his/her genital organs. During this phase of pregenital sexuality, positive,
possessions, or love feelings are directed mainly toward the parent of the opposite sex.
Through play, the child may express questions; fears, anger and misunderstanding abort his
illness and care. Other people may be significant to the child, depending on frequency and
duration of contact and warmth of the relationship, e.g., baby sitter, neighbours.

Cognitive Development

The preschooler is able to consider the views of another and his thinking becomes less
egocentric. he can solve a problem intuitively on the basis of only one aspect of a situation.
The knowledge of the preschooler is closely linked to his concrete experiences. If two
events are related to time or space, the child links them in casual fashion. The child begins
to reason from the general to the particular.

The preschooler begins to understand the behaviours considered to be socially right or

wrong. He is better able to identify behaviours that elicit rewards or punishment.
Vocabulary increases greatly and by 5 years of age the child has more than 200 words to
express himself. He can name colours and body parts.

ii) Developmental tasks

1) Acquisition of understandable speech and language

2) Learn to adjust and compromise
88
3) Communicate with other effect only Developmental Stages
of an Individual
4) Increased interpersonal relationship
5) Get prepared to got to school

4.5.4 School Age Child

i) Need

School age period is usually considered between to 6 to 12 years of age. Most cultures
provide some systemic, structured learning experiences during these years to assist children
in becoming productive, functioning members of the society, This age is a period of
transition from a life of free play to a life of structured play, learning and works. The
school age years are divided into juvenile period (6-9 yrs) marked by a need for per
associations, and preadolescence period between 9-12 years which is marked by new
capacity to love. The satisfaction and security of another person of the same sex is
important to the child.

Physical Development

During 6 to 12 years of age there is gradual and steady physical growth and development.
Height increases 2.2 to 4.4 cm per year and weight increases 3 to 6 pounds per year. During
this age large muscle coordination improves and children become more skilful in their
body movement. Fine motor coordination improves. Painting, drawing, playing computer
games and model making provides vehicle for children to practice and improve greatly
newly refined skill. The temperature, pulse and respiration approach adult normal. The first
permanent tooth starts erupting deciduous or baby teeth are lost and replaced.

Nurtritional requirements remain stable and children need well balanced diet. Nurses need
to encourage parents to provide nutritious snacks to children. During this age nurses should
encourage the children to pursue various activities to improve refined skills.

The preadolescent grows rapidly and exhibits secondary sex characteristics. There is an
increase in fat deposition and females have more subcutaneous fat deposit and the fat is lost
at a slower rate. Injury and trauma are common at this stage.

Psychosocial Developments

According to Erikson, this is the stage of developing achievement Vs inferiority. A sense of

achievement comes from success with effort. They develop independence in activities of
daily living. The child should be involved in decision-making. Children enjoy group
games. They learn to contribute, collaborate and work cooperatively towards a common
goal. They prefer companion of same sex and view opposite sex negatively. The child
views rules as necessary principles of life. Identity and self-concept becomes stronger and
more individualized. Nurse should organize programme for these children on topics that
encourage positive behaviour.

Cognitive Development

School age child develops capabilities for exploring, understanding and communicating an
understanding of the world. He is able to thinck abstractly, can use past information and
plan for the future. The child considers the views of others and his thinking is a more
socialized manner as he grows. Children learn the language of peers and adults. They are
able to link words into phrases and sentences. The child is beginning to make conceptual
thinking and abstract defining. Alongwith the verbal and formal reasoning h/she sees the
moral of a story.

ii) Developmental Tasks

While the school/child continues working on past taks, s/he is confronted with series of
new ones. These are:

1) Decreasing dependence upon family and gaining satisfaction from peers and other
adults.
2) Increasing neuro muscular skills so that s/he can participate in games 89
Concepts in Nursing 3) Learning basic adult concepts to be able to reason and engage in tasks of every day
living
4) Learn ways to communicate with others in cohereent ways
5) Becoming more active and cooperative family member
6) Learning socially acceptable ways in handling feelings and impulses
7) Adjusting with his changing body image and with muscular or feminine social role
8) Developing a positive attitude.

4.5.5 Adoloscents
i) Needs

The term adolescent refers to bio-psychological maturation of the individual. Puberty is the
biological maturation that makes reproduction possible. At this time increased hormonal
secretions lead to increased sexual drives and impulses. Adolescence is the period in life
which beings with puberty and extends from 8 to 10 years until, person is physically and
psychologically mature, ready to assume responsibilities and be self-sufficient because of
changes in intellect, attitudes and interact.

Physical Development

Adolescents undergo rapid physical changes including the development of primary and
secondary sexual characteristics. There is increased growth of skeleton, muscle and viscera.
The growth spurt girls generally begins between 10 to 14 years and for boys between 12 to
16 years of age. Height increases approximately 4 to 12 inches and weight increases by 15
to 60 pounds. Specific changes such as widening of shoulders in male and widening of hips
in females occur.

Reproductive system matures and secondary sex characteristics develop. Hormonal

changes contribute to the development of primary and secondary sex changes. The physical
maturity enables the female to begin mensturation and the male to produce spermatozoa.
Adolescents are sensitive about the physical changes. Nurses need to share the knowledge
of normal pattern of growth to reassure them that their growth pattern is normal.

The body’s metabolic rate increases; thus the nutritional needs also increase. They have
increased appetite. The cause of accidents in this age group is motor vehicles and fights
among rival groups. Other health problems are obesity, acne, pregnancy, venereal diseases
and substance abuse.

Psychosocial Development

This is the most difficult adjustment during adolescence. The social groups of boys are
larger and more loosely knit whereas those of girls are smaller and more sharply refined.
Physical changes of puberty enhance the achievement of sexual identity and development
of masculine and feminine behaviour. Adolescents seek a group identity. Popularity with
opposite sex and same sex peers is important. Adolescents try to talk about God and
religion. This is a period of a transition form family group to peer group. Adolescents need
to make choices, independently and experience the consequences of actions. The family
needs to allow independence providing supportive environment in which adolescents can
contemplate actions. During this period one selects an occupational or vocational direction
in life. Adolescents achieve high level of moral judgement. They learn to understand rules
and learn to apply rules by using their own judgement.

Adolescents tend to compare themselves to others, which lead to anxiety, Adolescents may
be reluctant to have medical examinations that intensify sexual feelings and guilt. It also
arouses fear of finding abnormalities. The adolescents manifest intensified feelings and
mood swings. They often express feelings in actions instead of words.

Tasks of adolescence include consolidation of a sense of self-identity; control of feelings;

learning to work and play with members of both sexes and establishment of sexual
relationships.
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Cognitive Development Developmental Stages
of an Individual
Adolescents are capable of formal operations in which they can separate real from the
possible. They can use deductive reasoning and can consider logic of a problem. They can
even solve problems requiring simultaneous manipulation of several abstract concepts.
adolescents develop workable philosophy of life; this requires abstract and analytical
thinking. They use scientific approach to problem solving. Language development is fairly
complete by adolescence, although vocabulary continues to expand.

ii) Developmental Tasks of Adolescents

1) Accepting the body changes and its functions

2) Understanding the meaning of physical maturity.
3) Achieving a satisfying and socially accepted feminine/masculine role.
4) Finding the self as a member of one or more peer groups and developing skills in
relating to a variety of people
5) Achieving independence from parents and other adults at the same time maintaining
an interdependence with them.
6) Selecting a satisfying occupation in time with interests, abilities and preparing for
economic independence.
7) Developing the intellectual and work skills and social sensitivities of a competent
citizen.
8) Developing a workable philosophy, a mature set of values and ideals.

4.5.6 Adulthood and Middle Age

The person is said to have attained adulthood with the completion of physical maturation
and has become sufficiently well integrated and emotionally mature to utilize the
opportunities and accept the responsibilities which accompany it. By this age, most men
and women have learned to accept their physiques. Since not much can be done to their
appearance, the adults major concern is to improve it. As a person grows, the signs of aging
like weight gain, gray hair, dry and wrinkled skin etc. become areas of concern. Any
physical defect or deformity may become serious adjustment problem as it may prove to be
serious handicap to getting jobs, making friends or marrying. The most creative periods
often come from people in their twenties. Adults are expected to assume many duties and
responsibilities. There is a slow but continuous rise in intelligence. Mental abilities reach at
peak. The young adult will be under stress if his high aspirations are not matched with
achievements. It he overstrains himself to achieve his high expectations it will lead to
stress, emotional breakdown and cause psychosomatic problems.

The most significant problems that affect the young adult include drug abuse, alcohol
depondence, depression and difficulties in marital adjustments.

Middle Age is marked by physical and mental changes. Middle-aged persons are usually in
fairly good physical and emotional health and financially secure. They have recognized
their intellectual abilities, established themselves in the social world and found ways to
meet their spiritual needs.

The man is well established in work. His experiences are found very valuable. He
experiences certain changing roles such as parenthood, work, spouse, sex role etc. Most
working adults spend more time at their occupations than at any other single activity. The
other problems faced during the age include excess fat deposition, anxiety, Diabetic
mellitus, cardiac problems, menopause, osteoporosis, alcoholism, depression, Alzheimer’s
disease etc.

4.5.7 Old Age

Old age is the last developmental stage of life. This stage begins between 65 and 75 years
of age. The poupulation of this group is increasing rapidly. Health care professional need to
work to improve quality of their life. Physiological, cognitive and psychosocial health of
older adults poses special challenges in meeting their health needs. 91
Concepts in Nursing Establishing satisfactory living arrangement is one of the important tasks of elderly. If an
elderly person’s living arrangements are inadequate it may lead to loneliness, anxiety,
depression etc. Adjusting one’s standard of living to a reduced income after retirement is
another important task to be accomplished. Retirement also provides a person with more
leisure time. Elderly people need to establish comfortable routine after retirement.
Maintaining love, sex and marital relationships is another task of elderly. Provided elderly
are healthy, they are capable of active sex life. Elderly people have the desire to keep active
and involved by sharing knowledge and experience with younger generation. They have
strong need to stay in touch with other family members. Loneliness can lead to depression
and suicidal thoughts. Old age people have a strong need to sustain and maintain their
physical and mental health. Aged person’s fear loss of control over daily routines, loss of
identity and social isolation because of failing health. Aged people are eager to talk about
‘days gone by’. They teach not from books but from their long experience in living.

To improve the quality of life for aging persons the elderly should be involved in society.
They should be permitted to work instead of being forced into retirement. They feel more
secured and useful when they continue to work. Public transport system and health systems
should improve facilities for elderly. Elderly are prey for youth gangs and burglars. They
should be provided more safety and security by the public.

Check Your Progress 2

Match the items in Column A with items in Column B. Place an appropriate number from
Column B in the space given in front of the statement in Column A.

Column A Column B
1) Begins to understand the behaviour a) Infancy
considered to be socially right or wrong
2) Mental abilities reach at peak b) Toddler
3) Learns to differentiate I from ‘not I’ c) Preschooler
4) Able to think abstractly d) School age child
5) Development of primary and secondary e) Adolescent
Sexual characteristics.
6) Increasing independence due to greater f) Adulthood
Physical mobility and cognitive abilities

4.6 DEATH AND DYING

Birth and death are universal. Dealth is an ineviatable event that every individual faces at
the end of life. Death is an overwhelming experience that affects the dying person, as well
as the family, friends and care giver. Humans are able to anticipate personal death. This
generates different feelings in different persons. It may cause anxiety, denial, loneliness,
love, achievement and lack of achievement. To the family death means the experience of
loss, grief, coping with loss of the process of mouring.

Emotional Stages associated with process of dying

In 1969, Ross presented with five possible stages of dying experienced by the patient and
loved ones. 1st stage is ‘Denial’ where initial shock occurs. It may last for few minutes to
few months 2nd stage is ‘Anger’ which is directed to self, God and others. Third stage is
‘Bargaining’ in which the individual attempts to postpone death, which is the dreaded
moment. Fourth stage is of ‘Depression’. Finally the individual reaches fifth stage of
‘Acceptance’ wherein he accepts death as inevitable.

A cli0ent experiences many emotions depending on the stage of dying. Thr nurse must
recognize that each emotion serves a purpose.

Tasks of dying

The dying has a limited time period ending in death, in which one make arrangements and
accomodations. Affairs need to be put in order. Accomodating onseself to one’s own loss
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requires introspection and meditation. To cope effectively with impending death is the most Developmental Stages
important task for a dying person. of an Individual

Patient’s Right

Each dying person has rights, which the nurses must understand and protect. He has the
right to be treated as a living being until he dies. He has the right to be treated with respect
and honesty. He has the right to be taken care of and the right to express his feelings and
emotions. He has the right to be free from pain and die in peace and dignity. He has the
right to discuss and carry out his religious or spiritual experiences, whatever they may
mean to others. He has the right to expect that the sanctity of the human body will be
respected after death.

Nursing care of the dying patient and his family

The dying person must be treated as a unique individual. The nursing care should foster the
optimum quality of life for the individual at that point of time. He and his family need to be
dealt within a secure and protected atmosphere. Meeting his physical needs and preventing
or alleviating his physical problems reassure the dying individual and his loved one. Nurses
need to provide required information to the client and the family. She must spend time
daily with individual. Listen rather than talk. Encourage him/her the to share and express
his feelings. Help the individual to have a peaceful death.

Check Your Progress 3

State the possible stages of dying as explained by Ross (1969)

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4.7 LET US SUM UP

In this unit you have learnt about some of the theories of development and needs, problems
and tasks of various developmental stages of an individual. Nursing practice based on
principles of growth and development helps the nurse to promote healthy development and
provide comprehensive nursing care to the clients.

Nursing practice based on principles of growth and development is organized and directed
toward helping individuals adapt to changing internal and external conditions. It involves
many complex changes in all dimensions throughout the life span.

The normal ranges of growth and development within each development stage helps the
nurse to access the client’s status and intervene, if necessary to promote healthy
development. Each stage is associated with certain physiological and psychosocial health
needs and risk factors. While providing nursing care to the clients the nurses awareness of
these elements is essential. Nurses can better access the needs of the client by keeping the
developmental perspective in mind. Nursing interventions for an individual should help
promote cognitive and psychosocial development of the individual. The nurse who
understands the interrelationship of physiological, cognitive and psychosocial needs and
their influence on overall health assesses life changes as a part of the nursing history.

4.8 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1

1) Refer to section 4.2

2) a) Oral stage
b) Anal stage
c) Phallic stage
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Concepts in Nursing d) Latency stage
e) Genital stage
3) a) Heredity
b) Environment
c) Self

Check Your Progress 2

1) 1) c
2) f
3) a
4) d
5) e
6) b

Check Your Progress 3

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

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