Care of Mother, Child and
13
Adolescents (Well Client)
YNA MANUALES, RN
THEORIES OF DEVELOPMENT
OUTLINE
I Introduction
II Diagnosing Severity of Anemia
A Moderate Anemias
B Severe Anemias
III Laboratory Diagnosis of Anemia
A RBC Indices
i
ii
ECOLOGIC SYSTEMS THEORY OF DEVELOPMENT
URIE BRONFENBRENNER (1917-2005)
• Ecologic Systems Theory of Development
o Interacting with the environment at
different levels or systems
o Each system contains roles, norms, and
rules that shape the child’s development
5 LEVELS OR SYSTEMS
1. MICROSYSTEM – close relationships on a daily
basis (e.g., Parents, Family, Friends in the
community)
2. MESOSYSTEM – relationship of microsystems
with one another (e.g., Parents receiving
feedback from the school teacher of the child)
3. EXOSYSTEM – settings that may influence the
child but may not have daily contact with
(e.g., Job of parents, Wage of parents, Local
School Board)
4. MACROSYSTEM – geographic location,
socioeconomic status, ethnicity, as well as the
attitudes & beliefs of the child’s culture and
society (e.g., A bigger community)
5. CHRONOSYSTEM – pattern of environmental
events and transitions in the child’s life (e.g.,
Divorce, transitions, moving from one place to
another)
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REFERENCES
“PROF’S PPT ON QUIPPER AND LECTURE”
IX. THEORIES OF MORAL DEVELOPMENT
Moral Development
- learning what ought to be & what not to be done
- “Moral” – relating to right and wrong
“Morality” – requirements necessary for people to
live together in society
1. LAWRENCE KOHLBERG
Lawrence Kohlberg 1927-1983
- Born in New York City in 1927
- Graduated from the university of Chicago in one year
- Attended Yale and earned a PhD in psychology
- Became fascinated by moral development in children
- Theorized Six stages of Human Moral Development
- Expanded on the earlier work of Cognitive Theorist
Jean Piaget to explain the moral development of
children, which he believed follows a series of stages
Moral Development Theory - focused on the reasons
why an individual makes a decision - moral
development progresses through 3 levels & 6 stages
Stages of Moral Development
Pre moral –
1) Obedience and Punishment
2) Individualism and exchange
Conventional
3) Good interpersonal Relationships
4) Maintaining Social Order
Post- Conventional
5) Social Contract and individual rights
6) Universal Principles
1
PREMORAL / PRECONVENTIONAL STAGE (LEVEL 1 CONVENTIONAL STAGE (LEVEL 2)

Age Stage Description

Preconventional Level (1)
Age Stage Description
2-3 1 Punishment & Obedience
Conventional (Level 2)
✔Punishment & Punishment
Orientation
✔Child does right because a Good Interpersonal
parent tells him or her to Relationships(Mutual
✔Avoids punishment Interpersonal Expectations,
✔The activity is wrong if one is Relationships & Conformities)
punished and the activity is right
if one is not punished ✔Good Boy, Nice Girl
Orientation ✔Decisions and
4-7 2
Individualism & Exchange behavior are based on concerns
(Instrumental Purpose & 7-10 3 about other’s reactions; the child
Exchange)
wants others’ approval ✔Child
✔Instrumental Orientation
follows rules because of a need to
✔Conformity is based on be a “good person” in their own
egocentricity and narcissistic
eyes and eyes of others
needs
✔Will do something for another Maintaining Social Order(Social
person if that person System & Conscience
10-12 4
Maintenance)

✔Law & Order Orientation

✔Right behavior is obeying the
law & following the rules ✔Child
follow rules of the authority figure,
as well as the

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 POST CONVENTIONAL (LEVEL III) 2. CAROL GILLIGAN

Age Stage Description

POST CONVENTIONAL CAROL GILLIGAN (1936-present)
(LEVEL III) -known for her research in the moral development of
Older 5 Social Contract & women
than Individual - includes the concepts of caring & responsibility in
12 Rights(Prior Rights moral decisionmaking
& Social Contract) - follows Kohlberg’s stages of moral development but
based upon research on women
✔Social Contract
Orientation ✔The
social rules are not CAROL GILLIGAN’s Theory of Moral Development
the sole basis for
decisions and
behavior because
3 levels of moral development
the person believes Stage 1: caring for oneself
that a higher moral
principle applies, Stage 2: caring for others
Older 6 such as equality, Stage 3: caring for self & others
than justice or due
12 process ✔Follows Pre- Conventional – Goal is individual survival
standards of society - Self needs and needs of self
for the good of all Conventional – Self sacrifice is goodness
people - Thinking about the needs of others
Post- Conventional -Principle of Nonviolence
Universal Ethical Do not hurt others or self
Principles - Truth – a development morality balancing the above
✔Universal Ethical
Principle
Orientation
✔Decisions and
behaviors are based
on internalized
rules, on conscience
rather than social
laws, and on self-
chosen ethical and
abstract principles
that are universal,
comprehensive and
consistent

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 imaginatio
SPIRITUAL DEVELOPMENTAL THEORY ns
Stage 2: School Age • Accepts
JAMES W. FOWLER (1940-2015) Mythical-Literal (7-12 y.o) existence
faith of a deity
• American theologian who was professor of • Religious
theology and human Development at Emory and moral
University beliefs are
• He suggests that Spirituality is a basic aspects symbolized
of human existence that develops in by stories
predictable ways, just like cognition, social Myths are
used to
behavior and motor skills.
communicate
• He also states that “it is the way of relating
spiritual
Universe and creating meaning” meaning
• Appreciate
other’s
JAMES FOWLER’S THEORY ON SPIRITUAL
view points
DEVELOPMENT • Accepts
concept of
reciprocal
STAGE DE AGE CHARACTERISTICS fairness
Stage 0: Infant- • Child
Undifferentiated Toddler learns to
Stage 3: Adolescenc • Questions
Faith (0-3 y.o.) :rely on the
Synthetic- e values and
goodness(
Conventiona religious
or
l Faith beliefs in an
badness,
attempt to
or
form own
consistenc
identity
y) of the
• World and
world
ultimate
based on
environment
how that
structured
child is
by the
treated by
expectations
their
and
parents
judgement
Stage 1: Preschooler • Has no real
of others;
Intuitive- (4-6 y.o.) understand
interpersona
Projective faith ing of
l focus
spiritual
Stage 4: Late • Assumes
concepts
Intuitive- Adolescent responsibility
• Imitates
Projective and Young for own
parental
Faith Adult attitudes and
behaviors
beliefs
and
• Constructing
attitudes
one’s own
about
explicit
religion
system; high
and
degree of
spirituality
self-
• Able to use
conciousness
symbols
and their

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 Stage 5: Adult • Integrates 2. Affiliative Faith (childhood &early adolescent)
Conjunctive other During this stage, we associate with a group.
Faith perspectives We believe and act as the church dictates.
about faith 3. Searching Faith (late adolescence) In this
into own questioning stage, individuals discern on their
definition of understanding of fait as opposed to just accept
truth the group or church norms. This stage can
• Awareness of
attract and maintain the adolescent or turns
truth from a
the adolescent elsewhere for faith responses.
variety of
viewpoints 4. Owned Faith (early adulthood) This stage
Stage 6: Adult • Make concepts involves searching, exploring and finally
Universalizing of love and committing. It involves realizing our beliefs,
Faith justice tangible learning to live by them and actively witnessing
• Seeing all of what we believe.
humanity as
one LIFE & FAITH – FAITH STAGES
brotherhood
and taking
profound, Self Rev’d Dr John H Westerhoff
-sacrificing
1. Experienced Faith
action to care
“This is what we do, this is how we act.”
for all
humanity 2. Affiliative Faith
• Very Few “This is what we believe, this is our church
people will (group).”
reach in this 3. Searching Faith
stage “Is this what I believe?”
4. Owned Faith
“This is what I believe.”
FAITH DEVELOPMENT/FAITH FORMATION
THEORY
1981: THREE STAGES OF FAITH DEVELOPMENT
JOHN WESTERHOFF III (1933-PRESENT)

❖ Faith Development/ Faith Formation
theory
- describes faith as a way of being &
infancy & childhood behaving that
evolves from an experienced faith
guided by parents & others
1976: FOUR STAGES OF FAITH DEVELOPMENT
According to John Westerhoff, the four main styles of
faith development are:
1. Experienced Faith (preschool & early
childhood) Children at this stage basically
imitate actions without understanding the
meaning. (e.g., If the parent will do sign of the
cross the child will imitate the parent)
Note: In 1981 Westerhoff modified his stages of Faith
Development and reduced it from four down to
three.
1. Affiliative Faith
• Our faith will be centered in the
community.
• (Dependent) depend on the beliefs of
the group.
2. Searching Faith
• In this stage we are building our own
beliefs
• (Independent) you will not depend on
the beliefs of the group instead you
believe on your own beliefs.
3. Mature Faith
“In this final stage we are governed by neither
the authority of the community nor our own
intellectual authority, but by personal union

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 with God through free acts of the will.
Interdependence integrated the dependence
of affiliative faith and the independence of
searching faith.”
• (Interdependent) combination of your
affiliative faith and searching faith,
you will still be involved in a group but
you have your own beliefs.
DEVELOPMENT OF SELF- CONCEPT
- How an individual describes himself or herself
- Not present at birth but develops gradually as a
result of unique experiences
- May or may not reflect reality
(How you would describe yourself, would not be how
others would perceived you or how others view you)
DEVELOPMENT OF SELF -CONCEPT
INFANCY
- awareness of one’s independent existence as
a result of social contact & experiences with
others
(it is up to the caregivers experiences if they
develop the thinking that they are independent)
(It is important that they (infants) would believe
that themselves are independent)
TODDLERHOOD
- more active as children explore the limit of
their capacities and the nature of their impact
on others
SCHOOL AGE
- more aware of differences among people,
more sensitive to social pressures
- become more preoccupied with issues of self-
criticism and self-evaluation
(The development of self-concept in a school-age child
depends on how others would view them they would
criticize and evaluate themselves, based on how other
people view them on their own behavior)
BODY IMAGE
ADOLESCENCE
- focus more on physical and emotional
changes and on peer acceptance
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(The development of self-concept depends on their
peers and how they look like physical and emotional
changes)
- a vital component of self-concept (PHYSICAL)
- refers to the subjective concepts & attitudes that
individual have toward their own bodies (HOW YOU
VIEW YOUR PHYSICAL BODY)
Consists of:
1. Physiological – perception of physical
characteristics (fat or thin)
2. Psychological – values & attitudes toward the body
(attitudes (happy or sad) towards presenting your
physical image of your body)
3. Social – self in relation to others (do you compare
your body to others)
BODY IMAGE ACROSS CHILDHOOD
INFANTS
- receive inputs about their bodies through self-
exploration and sensory stimulation from
others
TODDLERS
- learn to identify body parts
PRESCHOOLERS
- become aware of the wholeness of their
bodies and discover genitalia (PHALLIC STAGE)
- exploration of genitals and discovery of
differences between sexes
- vague concept on internal organs and
function (They are aware of their body parts
but not the internal organ)
SCHOOL AGE
- learn about internal body structure &
function
- more aware of the differences of body size
ADOLESCENT
- most concerned about the physical self
- face conflicts on what they see and what they
visualize as the ideal body structure
- body image development is a crucial element
in shaping identity
6
 (comparing themselves to other people and
seeking the acceptance of their peers if maganda
baa ng pagpresent ng kanilang body image)
SELF-ESTEEM
- refers to a personal, subjective judgment of
one’s worthiness (how do you perceived your
worth) derived from and influenced by the
social groups in the immediate environment &
individual’s perception of how they are
valued by others
- value that the individual places on oneself and
refers to overall evaluation of oneself
- affective (relating to feelings or emotions)
component of self
- ASPECTS: competence, sense of control,
moral worth, worthiness of love and
acceptance
TODDLERHOOD
- egocentric
- unaware of differences between competence
& social approval
(Increase self-esteem while exploring being
autonomous, does not necessary care about being
competent or about peers or about approval)
PRESCHOOL & EARLY SCHOOL-AGE CHILDREN
- positive feedback enhances self-esteem
- vulnerable to feelings of worthlessness
- anxious about failure
(the wont feel initiative or industrious enough in
school, they might feel worthless or anxious about
failing. They now have a concept of competence have
skills and capabilities they develop in this stage when
they get perform well in school the self-esteem will
increase)
EARLY ADOLESCENCE
- risk stage: defining an identity and sense of
self in the context of their peer group
(when competences increase and develop meaningful
relationship now their self-esteem increases or raises)
CHILD’S REACTION TO DYING & DEATH
INFANTS & TODDLERS
- lack understanding of the concept of death
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- aware that someone is missing (not
necessarily that someone has died)
- may experience separation anxiety
- infants: react to loss of caregivers with
behaviors such as crying, sleeping more,
eating less
- toddlers: may develop fearfulness & become
more attached to the remaining parent
PRESCHOOLERS
- view death as temporary & reversible
- magical thinking may lead to believe that the
dead person will come back
- view death as punishment: bad thoughts and
actions cause death
- first exposure to death: death of a pet
- common behaviors: nightmares, bowel and
bladder problems, crying, anger, and out of
control behaviors
SCHOOL AGE
- view death as irreversible, but not necessarily
inevitable
- by age 10, understands that death is universal
- may believe death as punishment for
wrongdoing
- may deny sadness and attempt to act as
adults
- common behaviors: difficulty concentrating in
school, psychosomatic complaints, acting out
behaviors or exhibiting improper actions to
relieve stress (tantrums, talking back to
parents or teacher, or exhibit bullying towards
classmates or poor performance in school)
ADOLESCENTS
- view death as irreversible (cannot come back
to life) , universal (will happen to everyone) &
inevitable (cannot be prevented)
- develop a better understanding between
illness & death
- common behaviors: feeling of loneliness,
sadness and fear, and acting out behaviors
(risk-taking (extreme sports),
delinquency(smoking, excessive drinking,
promiscuity (acting out sexual behaviors)
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 INTERVENTION FOR HEALTH PROMOTION
DURING CHILDHOOD
ENVIRONMENTAL MANIPULATION (for younger children)
1. AUDITORY STRATEGIES (sense of hearing)
- Monitor sound levels within the
environment
- Soft soothing music should be played
2. VISUAL STRATEGIES (sense of seeing)
- use of variety color, form, texture, and
lighting (to stimulate the eyes of your
young children)
3. OLFACTORY STRATEGIES (sense of smell)
- Odors may affect children’s behavior -
Sources of unpleasant odor must be
removed
4. THERMAL STRATEGIES
- Too warm or too cold environments may
impose physiological demands on any
child
SLEEP PROMOTION
Intervention strategies:
1. Establishing and maintaining sleep patterns
(establish routine at bedtime or sleeping at
night or nap time; INFANT: naptime in the
morning and afternoon; OLDER CHILDREN nap
time in the afternoon)
2. Facilitating sleep (make sure that sleeping
condition is optimal that bed, ventilation and
lighting is conducive for sleeping
3. Applying behavior management strategies
4. Applying relaxation techniques
4. Spacing of food intake (how frequent meals
are and setting the time for meal times and
snack times)
5. Role modeling and socialization (eating with
the child, show the child the good and
positive eating patterns and habits when
incomes of eating)
FILIPINO BELIEFS ON G & D
1. Giving a bath to their child on Tuesdays and
Fridays will make the child unhealthy.
2. Stepping over a child who is sleeping will
hinder the child’s growth.
3. A family with thirteen children means good
luck.
4. During baptism, it is important to bring out
your child first ahead of the others so that he
will grow up a successful person.
5. After circumcision, a boy should not step on a
mortar and pestle; otherwise his organ will
grow as big as the mortar and pestle.
6. Children are advised not to bite banana
leaves, as this is believed to cause tooth
decay.
7. Newborns should sleep beside books or place
books under their pillows, so that they will be
intelligent as they grow.

(gives warm milk, drink or water, reads book for

relaxation, singing to the child, puts on relaxing music
in order to be calm and relax the child to facilitate
better sleeping)

NUTRITIONAL SUPPORT

Strategies:

1. Non-nutritive sucking (relieves stress and

tension)
2. Structuring sucking reflex (in order to suck
and feed properly/ effectively)
3. Proper positioning (how they hold the baby
while feeding)

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