Awareness & Sensitivity to Client’s Health Care Needs

1. Awareness & Sensitivity to Client’s Health Care Needs Lifespan Growth & Development Developed by Dede Carr, BS, LDA Karen Neu, MSN, CNE, CNP

2. Awareness & Sensitivity to Clients’ Health Care Needs Competency: • Describe the major stages of human development & basic health needs of humans • Differentiate between growth & development • Describe the common characteristics or principles of human growth & development • Describe human’s needs theory & Maslow’s Hierarchy of Needs Model

3. “There's only one corner of the universe you can be certain of improving, and that's your own self.” Aldous Huxley “The great thing in the world is not so much where we stand as in what direction we are moving.” Oliver Wendell Holmes “The growth and development of people is the highest calling of leadership.” Harvey S. Firestone “You’ve got to do your own growing, no matter how tall your grandfather was.” Irish Saying “If you wish to achieve worthwhile things in your personal and career life, you must become a worthwhile person in your own self-development.” Brian Tracy

4. Growth Growth: Physical change & increase in size • Indicators of Growth • Height, Weight, Bone Size, & Dentition, Sensory Adaptation, & Development of sexual organs & characteristics • Although physical growth is similar for all people, growth rates vary during different stages of growth & development • Growth is rapid during prenatal, neonatal, infancy, & adolescence, but slows during childhood & is minimal during adulthood (Ramont & Niedringhaus, 2008)

5. Development Development: An increase in complex functions & progression of skills • Development refers to a person’s capacity & skill to adapt to the environment • Development is the behavioral aspect of growth & includes abilities to walk, talk, & run, speak, etc. (Ramont & Niedringhaus, 2008)

6. Principles of Growth & Development

7. Principles of Growth & Development • Growth & development take place in an organized way, but do not progress at same rate with all individuals • Cephalocaudally: Growth & development progresses from the head (cephalo) to tail ((caudal); for example an infant gains head control before control of extremities • Proximal to Distal: Growth & development progress from the center of the body outward-body’s midline to extremities (infant rolls before grasp is perfected) • General to Specific: Walking is learned before running or skipping Growth & development are independent, interrelated processes: Muscles, bones, & nervous system must grow to certain point before one can walk (Ramont & Niedringhaus, 2008)

8. Growth & Development Principles Growth & Development • Continuous, orderly, & sequential processes influenced by maturity (age), the environment, & genetic factors • Each stage is predictable, although the time of onset, length of stage, & effects of each stage varies with persons • Each developmental stage has its own characteristics • Development proceeds from simple to complex or from single acts to integrated acts (Ramont & Niedringhaus, 2008)

9. Growth & Development Principles • Development becomes increasingly differentiated (advance from general response to skilled specific response) • Example: An infant’s response to a stimulus involves the whole body while a five year old might respond with laughter • Certain stages are more critical than others (1st 10-12 weeks after conception most critical—risks for defects from exposure to viruses, chemicals, & drugs • Uneven pace of growth & development (ex. Rapid spurts of growth during prenatal, neonatal, infancy, & adolescence periods) (Ramont & Niedringhaus, 2008)

10. Sequence of Development--Order for Infants • 2 Months • Able to lift head up on his own • 3 Months • Can roll over • 4 Months • Can sit propped up without falling over • 6 Months • Able to sit up without support • 7 Months • Begins to stand while holding onto things for support • 9 Months • Can begin to walk, still using support (All Psych & Heffner Media Group, Inc., 1999-2003) • 10 Months • Able to momentarily stand on her own without support • 11 Months • Stand alone with more confidence • 12 Months • Begin walking alone without support • 14 Months • Walk backward without support • 17 Months • Walk up steps with little /no support • 18 Months • Manipulate objects with feet while walking, such as kicking a ball 

11. Factors that Influence Growth & Development Genetic inheritance—remains unchanged throughout life & determines characteristics: sex, physical stature, & race Environmental • Family • Religion • Schools • Climate • Culture • Community • Nutrition (Ramont & Niedringhaus, 2008) (www.saintbarnabas.com, n.d.)

12. Growth & Development: Why is it important in health care? • Knowledge of growth & development is essential when working in health care occupations because it is necessary to identify needs & problems (varies with age & developmental stage) & necessary to decide what & how to provide the appropriate health promotion/care needed. • It encompasses the prenatal period throughout the lifespan (fetus to neonate to old adult including physiological, psychosocial, cognitive, moral, & spiritual aspects of each life stage • Remember how you care for someone will depend on their age, size, mental, physical, & emotional abilities—(growth & development) (Ramont & Niedringhaus, 2008)

13. Components of Human Growth & Development

14. Relationship between Growth & Development • Each person’s rate of growth & development is highly individualized, but sequence (progress) is predictable Five Major Components of Growth & Development • Physiological: Relates to human body • Psychosocial: Relationship between oneself & others; emotions (love, hate, fear, anxiety, joy), attitudes, • Cognitive: An awareness of & interaction between oneself & environment; development of intelligence, conscious thought, & problem-solving ability that begins in infancy • Moral: Relates to judgments of right & wrong • Spiritual: Pertains to relationship with a higher power (God) (Ramont & Niedringhaus, 2008)

15. Life Stages & Developmental Tasks • As people mature from infancy to old age, persons pass through several developmental stages as identified in each of the five components of growth & development • Developmental tasks have to be accomplished at each of the developmental stages in order for the person to progress. • There are several developmental tasks that one should achieve in each of the physiological, psychosocial, cognitive, moral, & spiritual growth experiences (Ramont & Niedringhaus, 2008)

16. Lifespan Growth & Development Activity Assignment: Lifespan Growth &Development.” • Complete the Worksheet as a Word Document

17. Components of Growth & Development Physiologic Component

18. Physiological Component Pertains to the “body” Growth: • Physical change & increase in size; Can be measured quantitatively • Indicators of growth includes height, weight, bone size, & dentition Growth rates vary during different stages of growth & development • Growth rate is rapid during the prenatal, neonatal, infancy & adolescent stages & slows during childhood • Physical growth is minimal during adulthood (Human Growth and Development Theories, 2008)

19. Physiological Component Development of the Body: • Increases in the complexity of functions & skills progression (what a person can do, such as walking, running, skating, feeding self, etc.) • Capacity & skill of a person to adapt to the environment Development is the behavioral aspect of growth (Ramont & Niedringhaus, 2008)

20. Components of Growth & Development Cognitive Component

21. Cognitive Component • The cognitive theory cited most often in the cognitive development in children is Jean Piaget’s (1896-1980) theory. • As with all stage theories, Piaget’s Theory of Cognitive Development maintains that children go through specific stages as their intellect & ability to see relationships matures • These stages are completed in a fixed order with all children, even those in other countries • The age range, however can vary from child to child (All Psych & Heffner Media Group, Inc., 1999-2003)

22. Piaget’s Theory of Cognitive Development Cognitive refers to the process of acquiring knowledge by the use of reasoning, intuition, or perception; relating to thought processes (Encarta Dictionary) There are Four stages in Piaget’s Cognitive Development Theory • Sensorimotor Stage [0-2 years] • Preoperational Stage (Divided into 2 Phases) • Preconceptual [2-4 years] • Intuitive [4-7 years] • Concrete Operations Stage [7-11/12 years] • Formal Operations Stage [11/12 years & upwards] (All Psych & Heffner Media Group, Inc., 1999-2003) See the following slide showing the diagram of Piaget’s Cognitive Development Theory

23. Cognitive Component (www.businesswisespeaking.com, n.d.)

24. Cognitive Component of Growth & Development See the following slides for explanations and examples of each of the stages of Piaget’s Theory of Cognitive Development as depicted on the diagram. Think of someone you know for each of the stages of cognitive development.

25. Cognitive Stage #1: Sensorimotor Stage (Birth – 2 years) During this stage, child learns to manipulate objects although they fail to understand the permanency of these objects if they are not within their sight (current sensory perception). In other words, once an object is removed from the child’s view, he/she is unable to understand that the object still exists. Major achievement is Object Permanency (ability to understand that these objects do in fact continue to exist) Includes child’s ability to understand that when mom leaves the room, she will eventually return, resulting in an increased sense of safety & security Object Permanency occurs during end of this stage & represents child’s ability to maintain a mental image of the object (or person) without the actual perception or seeing the object (or person) (All Psych & Heffner Media Group, Inc., 1999-2003) [Image from www.lobo.sbc.edu]

26. Stage #2: Preoperational Stage Stage #2--Phase #1: Preconceptual (2-4 years) • Marked by “Egocentrism” (Child’s belief that everyone sees the world the same way that he/she does) • Everything is significant & relates to “me” • Child explores the environment • Develops language at a rapid pace • Associates words with objects Child fails to understand the differences in perception & believes that inanimate objects have the same perceptions the child does, such as seeing things, feeling, hearing & the sense of touch (All Psych & Heffner Media Group, Inc., 1999-2003)

27. Stage #2: Preoperational Stage Stage #2-Phase #2 Intuitive Thought (4-7 years) • Children learn how to interact with their environment in a more complex manner through the use of words & images • Egocentric (“me”) thinking diminishes; child thinks of one idea at a time • Includes others in the environment & learns to play with their peers, increasing the number of friends as they grow older • Child’s words express thought & they learn about feelings: cry, sad, laugh related to the words • Child gradually emerges as social beings (Berman et al., 2008, p. 210) (www.littlescholarspreschoolfl.com, n.d.)

28. Stage #2: Preoperational Stage • A second important factor in this stage is that of conservation (ability to understand that quantity does not change if the shape changes) • In other words, if a short & wide glass of milk is poured into a tall & thin glass, children will perceive the taller glass as having more milk due only because of it’s height • Children’s inability to understand reversibility & their focus on only one aspect of a stimulus is called centration; (Focus is only on height as opposed to understanding other aspects as glass width (All Psych & Heffner Media Group, Inc., 1999-2003) (www.clips.tojsiab.com, n.d.)

29. Cognitive Stage #3: Concrete Operations Between ages 7-11/12 years Stage #3 is marked by a gradual decrease in centristic thought & the increased ability to focus on more than one aspect of a stimulus or item Children can understand the concept of grouping, knowing that a small dog & a large dog are still both dogs, or that pennies, quarters, & dollar bills are part of the bigger concept of money They can only apply this new understanding to concrete objects (those they have actually experienced) In other words, imagined objects or those they have not seen, heard, or touched continue to remain somewhat mystical to these children, & abstract thinking has yet to develop (All Psych & Heffner Media Group, Inc., 1999-2003)

30. Cognitive Stage #4: Formal Operations (12 years & Beyond) Children begin to develop a more abstract view of the world They are able to apply reversibility & conservation to both real & imagined situations; They develop an increased understanding of the world & the idea of cause & effect By teenage years- they are able to develop their own theories about the world; Stage #4 is achieved by most children, although failure to do so has been associated with lower intelligence Early in the period there is a return to egocentric (focus on “me”) thought (All Psych & Heffner Media Group, Inc., 1999-2003)

31. Cognitive Stage #4: Formal Operations (12 years & Beyond) • Moving from concrete to formal thinking, & driven by a sense of urgency, teens may want it all, right here, right now! • Not unlike the terrible twos, teens are craving to break loose, to look at the other side of the fence, & to take a walk on “the wild side” • Teens fight for the emergence of their own will, while seeking love from trusted ones • Teenagers are on a quest to answer satisfactorily & happily the question "Who am I?" • They will seek the leadership of chosen others, & gradually develop a set of ideals, socially congruent & desirable in the case of successful integration Furthermore, in the process of growing up they will acquire a sense of self worth & establish clear sexual identities (Lego Group, 2011)

32. Components of Growth & Development Moral Component

33. Kohlberg’s Levels of Moral Development Kohlberg’s (1973) stages of moral development breaks our development of morality into three levels, each of which is divided further into two stages: Pre-conventional Level (up to age nine): ~Self Focused Morality~ Conventional Level (age nine to adolescence): Other Focused Morality~ Post-conventional Level (adulthood): ~Higher Focused Morality~ (Ramont & Niedringhaus, 2008, p. 208)

34. Moral Component of Growth & Development (Kohlberg, 1981)

35. Kohlberg’s Levels & Stages of Moral Development

36. Kohlberg’s Levels of Moral Development • Pre-conventional Level (up to 9 years): • Self-focused morality • Morality is defined as obeying rules & avoiding negative consequences • Children in this stage see rules set, typically by parents, as defining moral law • That which satisfies the child’s needs is seen as good & moral—most actions taken by the child are to satisfy the child’s own needs • They believe that activity is wrong if one is punished & activity is right if one I not punished (Ramont & Niedringhaus, 2008, p. 208)

37. Kohlberg’s Levels of Moral Development Conventional Level (9 years to adolescence): • Other -focused morality (think of others rather than self • Children begin to understand what is expected of them by their parents, teacher, etc. • Morality is seen as meeting or achieving these expectations • Fulfilling obligations as well as following expectations are seen as moral law for children in this stage • Action is taken to please another & gain approval • Right behavior is obeying the law & following the rules (Ramont & Niedringhaus, 2008, p. 208)

38. Kohlberg’s Levels of Moral Development Post-conventional Level (adulthood): • Higher-focused morality • Adults begin to understand that people have different opinions about morality & that rules & laws vary from group to group & culture to culture • Morality is seen as upholding values of one’s group or culture • Understanding one’s own personal beliefs allows adults to judge themselves & others based upon higher levels of morality • What is right & wrong is based upon the circumstances surrounding an action (Ramont & Niedringhaus, 2008, p. 208)

39. Kohlberg’s Stages of Moral Development Post-conventional Level (adulthood): • Basics of morality are the foundation with independent thought playing an important role • Standards of behaviors are based on adhering to laws that protect the welfare & rights of others • Personal values & opinions are recognized, & violating the rights of others is avoided • Universal moral principles are internalized • The person in this stage respects other humans & believes that relationships are based on mutual trust (Ramont & Niedringhaus, 2008, p. 208)

40. Moral Component of Development • The following slide shows two versions of the moral development tasks as an individual matures & progresses through the moral developmental stages according to Kohlberg Use the diagrams of Kohlberg’s theory as a review & think of where you are in your moral development.

41. Kohlberg’s Levels & Stages of Moral Development

42. Moral & CognitiveDevelopmental Stages The following slide shows the two theories of development—one is Piaget’s cognitive development stages & the other is Kohlberg’s levels and stages of moral development. Both are interrelated.

43. Moral & Cognitive Components of Developmental Stages (www.withfriendship.com, n.d.)

44. Components of Growth & Development Psychosocial Component

45. Psychosocial Component

46. Psychosocial ComponentDevelopment of Personality • Psychosocial development refers to the development of personality, a complex concept—difficult to define • Consider as outward (interpersonal) expression of inner (intrapersonal) self • Encompasses a person’s temperament, feelings, self-esteem, character traits, independence, self-concept, behavior, ability to interact with others, & ability to adapt to life changes (Berman et al., 2008, p. 350) The following slides show the stages, age range, & Erikson’s Psychosocial Stages (central tasks)

47. Psychosocial Component of Growth & Development • Psychosocial aspects of each life stage are based on Erikson’s Stages of Psychosocial Development • Erikson studied human responses to life’s events to gain an understanding of how attitudes & behaviors change throughout the lifespan • In each stage, Erikson believed people experience a conflict that serves as a turning point in development (Berman et al., 2008, p. 350)

48. Erikson’s Psychosocial Developmental Stages • Conflicts centered on either developing a psychological quality or failing to develop that quality • During these times of conflict, the potential for personal growth is high, but so is the potential for failure to accomplish the devel0pmental tasks • Once the conflicts are successfully resolved the individual advances to the next stage of development (Berman et al., 2008, p. 350)

49. Erikson’s Developmental Stages (www.willsavive.blogspot.com, n. d.)

50. Erikson’s PsychosocialStages of Development