Erik Erikson’s theory of psychosocial development is one of the best-known theories of personality in psychology. Erikson believed that personality develops in a series of stages. Erikson’s theory describes the impact of social experience across the whole lifespan. Erikson theory focuses on physical, emotional, and psychological stages of development. According to Erikson personality developed in eight developmental stages throughout life span and the need of each stage must be met or resolved before the move to the next stage. If individual needs are not met in a particular stage, it will affect the individual later in life. Erikson’s stages of development assessment findings of each age group and potential findings a nurse may discover includes: Infancy (birth to 18 months): Trust versus Mistrust.
Children begin to learn the ability to trust others based upon the consistency of their caregiver(s). If trust develops successfully, the child gains confidence and security in the world around him and is able to feel secure even when threatened. Unsuccessful completion of this stage can result in an inability to trust, and therefore a sense of fear about the inconsistent world. It may result in anxiety, heightened insecurities, and an over feeling of mistrust in the world around them. Early Childhood (2 to 3 years): Autonomy versus shame and doubt .
Children begin to assert their independence, by walking away from their mother, picking which toy to play with, and making choices about what they like to wear, to eat, etc. If children in this stage are encouraged and supported in their increased independence, they become more confident and secure in their own ability to survive in the world. If children are criticized, overly controlled, or not given the opportunity to assert themselves, they begin to feel inadequate in their ability to survive, and may then become overly dependent upon others, lack self-esteem, and feel a sense of shame or doubt in their own abilities. Preschool (3 to 5 years): Initiative versus guilt.
Children assert themselves more frequently. They begin to plan activities, make up games, and initiate activities with others. If given this opportunity, children develop a sense of initiative, and feel secure in their ability to lead others and make decisions. Conversely, if this tendency is squelched, either through criticism or control, children develop a sense of guilt. They may feel like a nuisance to others and will therefore remain followers, lacking in self-initiative. School Age (6 to 11 years): Industry versus inferiority.
Children begin to develop a sense of pride in their accomplishments. They initiate projects, see them through to completion, and feel good about what they have achieved. During this time, teachers play an increased role in the child’s development. If children are encouraged and reinforced for their initiative, they begin to feel industrious and feel confident in their ability to achieve goals. If this initiative is not encouraged, if it is restricted by parents or teacher, then the child begins to feel inferior, doubting his own abilities and therefore may not reach his potential. Adolescence (12 to 18 years): Identity versus role confusion. During adolescence, the transition from childhood to adulthood is most important. Children are becoming more independent, and begin to look at the future in terms of career, relationships, families, housing, etc.
During this period, they explore possibilities and begin to form their own identity based upon the outcome of their explorations. This sense of who they are can be hindered, which results in a sense of confusion (“I don’t know what I want to be when I grow up”) about themselves and their role in the world. Success in this stage leads to an ability to stay true and being focused while failure leads to role confusion and a weak sense of self or confused. Young Adulthood (19 to 40 years): Intimacy versus isolation. Young adults need to form intimate, loving relationships with other people. We explore relationships leading toward longer term commitments with someone other than a family member.
Successful completion can lead to comfortable relationships and a sense of commitment, safety, and care within a relationship. Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression. Middle Adulthood (40 to 65 years): Generativity versus. Stagnation During middle adulthood, we establish our careers, settle down within a relationship, begin our own families and develop a sense of being a part of the bigger picture. We give back to society through raising our children, being productive at work, and becoming involved in community activities and organizations. This leads to feelings of usefulness and accomplishment. By failing to achieve these objectives, we become stagnant and feel unproductive. Maturity (65 to death): Ego integrity versus despair.
As we grow older and become senior citizens, we tend to slow down our productivity, and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life. If we see our lives as unproductive, feel guilt about our pasts, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness. Summary of how nurses would handle physical assessment, examinations, education and communication differently with children versus adults. According to ( Javis 2012), Assessment is the collection of data about the individual health state. Edelman & Mandle ( 2010), defined health assessment as a tool used to detect health problem of an individual through proper physical examination, screening, health history which enable health care provider to have insight of the individual problem.
Assessment helps in dictating the actual diagnosis by identifying the signs and symptoms of the disease, knowing the patient cultures and beliefs will also help in developing proper health care plan for effective care delivery and health promotion. According to (Javis 2012), Children are unable to relay information concerning their health problem compared to adults due to their developmental stage. The nurse depends on the parents or care givers to get health information relating to the children. The child observation and the parent interview should be well documented. According to (Javis 2012), performing health assessment to toddlers may not be easy; head to toe assessment in a toddler may not be in sequence. Patience is needed by the nurse in conducting physical assessment in a child. Nurses often gain good rapport with children by giving toys, paper and crayon to them.
Nurses learning how to gain consent both in adults and in children will help in proper physical assessment of everyone and these includes: The skin: Assess for Birthmarks, pigmentation or color change, skin disease such as rashes, lesion and acne. Changes in the nail shape and bruises. Head: Assess for hair texture, alopecia, head injury, dizziness and headache. Eyes: Assess for glasses use, the date of last eye visit to you doctor. Check for redness, drainage, pupil size, pupil reaction, cataract, glaucoma, pain. Ear: Assess for any ear problems such as drainage, myringotomy tubes in ears, cerumen, ringing in the ear. Nose and Sinuses:
Assess for frequent cod, nose bleed, nasal stiffness and any allergies. Mouth and Throat:
Assess for cleft lip and palate, caries, sores in the mouth, tongue and throat, mouth breathing, difficulty in chewing, swallowing and hoarseness voice. Neck:
Assess for swollen glands and limitation of movements.
Assess for any nipple discharge, pain or any breast disease. Preadolescents and adolescents ask questions like when did they noticed breast changes in their body. Respiratory:
Assess for wheezing or noisy breathing, shortness of breath, chronic cough, croup or history of asthma. Cardiovascular:
Assess the shape of the chest wall; auscultate to dictate normal heart sounds or abnormal heart sound such as murmur. Assess for heart palpitation, dyspnea on exertion, coldness in extremities and normal or abnormal blood pressure. Gastro-intestinal System:
Assess for abdominal pain, frequent nausea/ vomiting, frequent bowel movements, the stool constituency diarrhea or constipation, use of laxatives, rectal bleeding and history of pinworms. Urinary System:
Assess for history of urinary tract infection, oliguria/ polyuria, urine color. Ask for any planned toilet training for the child, when it started. Is the child bedwetting? Do you know if there is any factor associated with this? Male genital System:
Assess the penis for pain. Check for lesions, drainage, swelling, hernia in the scrotum during crying. Preadolescents and adolescents boys assess for puberty changes and any sexual abuse. Female genital System:
Assess for genital itching, vaginal discharges, and rashes. Check for sexual abuse. Preadolescents and adolescents ask if their menstruation has started. Sexual Health:
Assess for sexually transmitted disease such as gonorrhea/ syphilis, herpes, chlamydia, HIV/ AIDS. Ask if the preadolescents or the adolescent are into a relationship involving sexual intercourse. Did she or he know about sexually transmitted diseases? Assess how a child reacts towards the opposite sex. Musculoskeletal System:
Assess for bone and joint pain, swelling, arthritis, stiffness, limited movement, coordination and gait strength. Assess for muscle strength, pain, cramps, weakness, posture, spinal curvature. Neurological System:
Assess for numbness and tingling sensation. Cognitive functions, mental retardations and cerebral palsy. Hematologic System:
Assess for excessive bruising, swelling of the lymph nodes, exposure to toxic agents and radiations. Endocrine System:
Assess the history of thyroid or diabetes disease such as excessive thirst, hunger or urination. Delay in puberty and abnormal hair distributions. Nurse should know the anatomy and physiology associated with body system to be able to differentiate normal findings from abnormal findings. Health assessment is performed according to developmental stages. The parents and care givers should relate important health information of a child to the nurse for effective health care delivery. All information gathered should be properly documented.
Erickson’s Stages of Psychosocial Development. Retrieved from
http://allpsych.com/psychology/101/social_development.html. Erickson’s Theory of Psychosocial Development in Infancy and Early Childhood. Retrieved:
Javis, Carolyn. Physical Examination & health Assessment, (Saunders2012).Sixth edition Carole Edelman, Elizabeth kudzma, Carol Mandle.
Health promotion throughout life span,
7th Edition ( 2010).