SEMINAR ON

THEORIES
PERSONALITY
DEVELOPMENT AND
RELEVANT TO
NURSING PRACTICE
SUBMITTED TO SUBMITTED BY

MR.BENNET RAJ MSC (N) R.ILAKKIYA

ASSISTANT PROFESSOR I YEAR MSC NURSING

NNC NNC
PERSONALITY DEVELOPMENT:

Personality development has been a major topic of interest for some of the most prominent thinkers in
psychology. Our personalities make us unique, but how does personality develop? How exactly do we become
who we are today? In order to answer this question, many prominent theorists developed theories to describe
various steps and stages that occur on the road of personality development. The following theories focus on
various aspects of personality development, including cognitive, social and moral development.

Defining Personality

While personality is something that we talk about all the time ("He has such a great personality!" or "Her
personality is perfect for this job!"), might be surprised to learn that psychologists do not necessarily agree on a
single definition of what exactly constitutes personality.Personality is broadly described as the characteristic
patterns of thoughts, feelings, and behaviors that make a person unique.

Characteristics of Personality

In order to understand the psychology of personality, it is important to learn some of the key characteristics of
how personality works.

 Personality is organized and consistent.1 We tend to express certain aspects of our personality in
different situations and our responses are generally stable. 
 Although personality is generally stable, it can be influenced by the environment.1 For example,
while your personality might lead you to be shy in social situations, an emergency might lead you to take on a
more outspoken and take-charge approach.
 Personality causes behaviors to happen. You react to the people and objects in your environment
based on your personality.1 From your personal preferences to your choice of a career, every aspect of your life
is affected by your personality.

Research Models

Now that you know a bit more about the basics of personality, it's time to take a closer look at how scientists
actually study human personality. There are different techniques that are used in the study of personality. Each
technique has its own strengths and weaknesses.
 Experimental methods are those in which the researcher controls and manipulates the variables of
interests and takes measures of the results. This is the most scientific form of research, but experimental
research can be difficult when studying aspects of personality such as motivations, emotions, and drives. These
ideas are internal, abstract, and can be difficult to measure. The experimental method allows researchers to look
at cause-and-effect relationships between different variables of interest.
 Case studies and self-report methods involve the in-depth analysis of an individual as well as
information provided by the individual. Case studies rely heavily on the interpretations of the observer,
while self-report methods depend on the memory of the individual of interest. Because of this, these methods
tend to be highly subjective and it is difficult to generalize the findings to a larger population.
 Clinical research relies upon information gathered from clinical patients over the course of treatment.
Many personality theories are based on this type of research, but because the research subjects are unique and
exhibit abnormal behavior, this research tends to be highly subjective and difficult to generalize.

Important Terminology

Classical Conditioning

Classical conditioning is a behavioral training technique which begins with a naturally occurring stimulus
eliciting an automatic response. Then, a previously neutral stimulus is paired with the naturally occurring
stimulus.

Eventually, the previously neutral stimulus comes to evoke the response without the presence of the naturally
occurring stimulus. The two elements are then known as the conditioned stimulus and the conditioned response.

Operant Conditioning

Operant conditioning is a behavior training technique in which reinforcements or punishments are used to
influence behavior. An association is made between a behavior and a consequence for that behavior.

Unconscious

In Freud’s psychoanalytic theory of personality, the unconscious mind is a reservoir of feelings, thoughts, urges,

and memories that are outside of our conscious awareness.2 Most of the contents of the unconscious are
unacceptable or unpleasant, such as feelings of pain, anxiety, or conflict.

Theories of Personality Development and relevance to nursing practice

□ Psychoanalytic Theory- Freud’s
□ Interpersonal Theory-Sullivan’s
□ Theory of Psychosocial Development-Erikson’s
□ Theory of object relations
□ Cognitive Development Theory
□ Theory of Moral Development
□ A Nursing Model-Hildegard E.Peplau

Psychoanalytic theory

Psychoanalysis was founded by Sigmund Freud (1856-1939). Freud believed that people could be cured by
making conscious their unconscious thoughts and motivations, thus gaining "insight". The aim of
psychoanalysis therapy is to release repressed emotions and experiences, i.e. make the unconscious conscious.
Psychoanalysis is commonly used to treat depression and anxiety disorders. It is only by having a cathartic (i.e.
healing) experience can a person be helped and "cured".

Id

The id according to Freud is the part of the unconscious that seeks pleasure. His idea of the id explains why
people act out in certain ways, when it is not in line with the ego or superego. The id is the part of the mind,
which holds all of humankind’s most basic and primal instincts. It is the impulsive, unconscious part in the
mind that is based on desire to seek immediate satisfaction. The id does not have a grasp on any form of reality
or consequence. Freud understood that some people are controlled by the id because it makes people engage in
need-satisfying behavior without any accordance to what is right or wrong. Freud compared the id and the ego
to a horse and a rider. The id is compared to the horse, which is directed and controlled, by the ego or the rider.
This example goes to show that although the id is supposed to be controlled by the ego, they often interact with
one another according to the drives of the id.

Freud defined the id as the part of the mind "cut off from the external world, that has its own world of
perception. It detects with extraordinary acuteness certain changes in its interior, especially oscillations in the
tension of its instinctual needs, and these changes become conscious as feelings in the pleasure-un pleasure
series. It is hard to say, to be sure, by what means and with the help of what sensory terminal organs these
perceptions come about. But it is an established fact that self-perceptions—co en esthetic feelings and feelings
of pleasure-un pleasure govern the passage of events in the id with despotic force. The id obeys the inexorable
pleasure.

Ego

In order for people to maintain a realistic sense here on earth, the ego is responsible for creating balance
between pleasure and pain. It is impossible for all desires of the id to be met and the ego realizes this but
continues to seek pleasure and satisfaction. Although the ego does not know the difference between right and
wrong, it is aware that not all drives can be met at a given time. The reality principle is what the ego operates by
in order to help satisfy the id’s demands as well as compromising according to reality. The ego is a person’s
"self" composed of unconscious desires. The ego takes into account ethical and cultural ideals in order to
balance out the desires originating in the id. Although both the id and the ego are unconscious, the ego has close
contact with the perceptual system. The ego has the function of self-preservation, which is why it has the ability
to control the instinctual demands from the id.

"The ego is first and foremost a bodily ego; it is not merely a surface entity, but is itself the projection of a
surface. If we wish to find an anatomical analogy for it we can best identify it with the ‘cortical homunculus’ of
the anatomists, which stands on its head in the cortex, sticks up its heels, faces backwards and, as we know, has
its speech-area on the left-hand side. The ego is ultimately derived from bodily sensations, chiefly from those
springing from the surface of the body. It may thus be regarded as a mental projection of the surface of the
body, representing the superficies of the mental apparatus."[3]

Superego

The superego, which develops around age four or five, incorporates the morals of society. Freud believed that
the superego is what allows the mind to control its impulses that are looked down upon morally. The superego
can be considered to be the conscience of the mind because it has the ability to distinguish between reality as
well as what is right or wrong. Without the superego Freud believed people would act out with aggression and
other immoral behaviors because the mind would have no way of understanding the difference between right
and wrong. The superego is considered to be the "consciousness" of a person’s personality and can override the
drives from the id. Freud separates the superego into two separate categories; the ideal self and the conscience.
The conscience contains ideals and morals that exist within society that prevent people from acting out based on
their internal desires. The ideal self contains images of how people ought to behave according to societies
ideals.

The unconscious

Freud believed that the answers to what controlled daily actions resided in the unconscious mind despite
alternative views that all our behaviors were conscious. He felt that religion is an illusion based on human
values that are created by the mind to overcome inner psychological conflict.[4] He believed that notions of the
unconsciousness and gaps in the consciousness can be explained by acts of which the consciousness affords no
evidence. The unconscious mind positions itself in every aspect of life whether one is dormant or awake.
[5]
 Though one may be unaware of the impact of the unconscious mind, it influences the actions we engage in.
[6]
 Human behavior may be understood by searching for analysis of mental processes. This explanation gives
significance to verbal slips and dreams. They are caused by hidden reasons in the mind displayed in concealed
forms. Verbal slips of the unconscious mind are referred to as a Freudian slip. This is a term to explain a spoken
mistake derived from the unconscious mind. Traumatizing information of thoughts and beliefs are blocked from
the conscious mind. Slips expose our true thoughts stored in the unconscious.[7] Sexual instincts or drives have
deeply hidden roots in the unconscious mind. Instincts act by giving vitality and enthusiasm to the mind through
meaning and purpose. The ranges of instincts are in great numbers. Freud expressed them in two categories.
One is Eros the self-preserving life instinct containing all erotic pleasures. While Eros is used for basic survival,
the living instinct alone cannot explain all behavior according to Freud.[8] In contrast, Tanat’s is the death
instinct. It is full of self-destruction of sexual energy and our unconscious desire to die.[9] The main part of
human behavior and actions is tied back to sexual drives. Since birth, the existence of sexual drives can be
recognized as one of the most important incentives of life

Psychosexual stages

Freud's theory of psychosexual development is represented amongst five stages. According to Freud, each stage
occurs within a specific time frame of one's life. If one becomes fixated in any of the four stages, he or she will
develop personality traits that coincide with the specific stage and its focus.

 Oral Stage - The first stage is the oral stage. An infant is in this stage from birth to eighteen months of
age. The main focus in the oral stage is pleasure seeking through the infant’s mouth. During this stage, the need
for tasting and sucking becomes prominent in producing pleasure. Oral stimulation is crucial during this stage;
if the infant’s needs are not met during this time frame he or she will be fixated in the oral stage. Fixation in this
stage can lead to adult habits such as thumb-sucking, smoking, over-eating, and nail-biting. Personality traits
can also develop during adulthood that are linked to oral fixation; these traits can include optimism and
independence or pessimism and hostility.

 Anal Stage - The second stage is the anal stage which lasts from eighteen months to three years of age.
During this stage the infant’s pleasure seeking centers are located in the bowels and bladder. Parents stress toilet
training and bowel control during this time period. Fixation in the anal stage can lead to anal-retention or anal-
expulsion. Anal retentive characteristics include being overly neat, precise, and orderly while being anal
expulsive involves being disorganized, messy, and destructive.
 Phallic Stage - The third stage is the phallic stage. It begins at the age of three and continues until the
age of six. Now sensitivity becomes concentrated in the genitals and masturbation (in both sexes) becomes a
new source of pleasure. The child becomes aware of anatomical sex differences, which sets in motion the
conflict jealousy and fear which Freud called the Oedipus complex (in boys). Later the Freud scholars added
Electra complex (in girls).
 Latency Stage - The fourth stage is the latency stage which begins at the age of six and continues until
the age of eleven. During this stage there is no pleasure seeking region of the body; instead all sexual feelings
are repressed. Thus, children are able to develop social skills, and find comfort through peer and family
interaction.

 Genital Stage - The final stage of psychosexual development is the genital stage. This stage starts from
eleven onwards, lasts through puberty, and ends when one reaches adulthood at the age of eighteen. The onset
of puberty reflects a strong interest from one person to another of the opposite sex. If one does not experience
fixation in any of the psychosexual stages, once he or she has reached the genital stage, he or she will grow into
a well-balanced human being.

Anxiety and defense mechanisms

Sigmund Freud proposed a set of defense mechanisms in one's body. These set of defense mechanisms occur so
one can hold a favorable or preferred view of themselves. For example, in a particular situation when an event
occurs that violates ones preferred view of themselves, Freud stated that it is necessary for the self to have some
mechanism to defend itself against this unfavorable event; this is known as defense mechanisms. Freud's work
on defense mechanisms focused on how the ego defends itself against internal events or impulses, which are
regarded as unacceptable to one's ego. These defense mechanisms are used to handle the conflict between the
id, the ego, and the super ego.

Freud noted that a major drive for people is the reduction of tension and the major cause of tension was anxiety.
[10]
He identified three types of anxiety; reality anxiety, neurotic anxiety, and moral anxiety. Reality anxiety is
the most basic form of anxiety and is based on the ego. It is typically based on the fear of real and possible
events, for example, being bit by a dog or falling off of a roof. Neurotic anxiety comes from an unconscious
fear that the basic impulses of the id will take control of the person, leading to eventual punishment from
expressing the id's desires. Moral anxiety comes from the superego. It appears in the form of a fear of violating
values or moral codes, and appears as feelings like guilt or shame

The defense mechanisms are as follows:

1) Denial- believing that what is true is actually false

2) Displacement- taking out impulses on a less threatening target

3) Intellectualization- avoiding unacceptable emotions by focusing on the intellectual aspects

4) Projection- attributing uncomfortable feelings to others

5) Rationalization- creating false but believable justifications

6) Reaction Formation- taking the opposite belief because the true belief causes anxiety
7) Regression- going back to a previous stage of development

8) Repression- pushing uncomfortable thoughts out of conscious awareness

9) Suppression- consciously forcing unwanted thoughts out of our awareness

10) Sublimation- redirecting ‘wrong’ urges into socially acceptable actions. These defenses are not under our
conscious control and our unconscious will use one or more to protect one's self from stressful situations. They
are natural and normal and without these, neurosis develops such as anxiety states, phobias, obsessions, or
hysteria.

Totem and Taboo

Freud desired to understand religion and spirituality and deals with the nature of religious beliefs in many of his
books and essays. He regarded God as an illusion, based on the infantile need for a powerful father figure.
Freud believed that religion was an expression of underlying psychological neuroses and distress. In some of his
writing, he suggested that religion is an attempt to control the Oedipal complex, as he goes on to discuss in his
book Totem and Taboo.

In 1913, Freud published the book, Totem and Taboo. This book was an attempt to reconstruct the birth and the
process of development of religion as a social institution. He wanted to demonstrate how the study of
psychoanalysis is important in the understanding of the growth of civilization. This book is about how
the Oedipus complex, which is when an infant develops an attachment for the mother early on in life, and incest
taboo came into being and why they are present in all human societies. The incest taboo rises because of a
desire for incest. The purpose of the totemic animal is not for group unity, but to re-enforce the incest taboo.
The totemic animal is not a symbol of God but a symbol of the father and it is an important part of religious
development. Totemism originates from the memory of an event in pre-history where the male group members
eat the father figure due to a desire for the females. The guilt they feel for their actions and for the loss of a
father figure leads them to prohibit incest in a new way. Totemism is a means of preventing incest and as a
ritual reminder of the murder of the father. This shows that sexual desire, since there are many social
prohibitions on sexual relations, is channeled through certain ritual actions and all societies adopt these rituals
so that sexuality develops in approved ways. This reveals unconscious desires and their repression. Freud
believes that civilization makes people unhappy because it contradicts the desire for progress, freedom,
happiness, and wealth. Civilization requires repression of drives and instructs such as sexual, aggression, and
the death instinct in order that civilization can work.

Sullivan’s Developmental Epochs

Infancy
Age birth to 1 year
From birth to about age one, the child begins the process of developing, but Sullivan did not emphasize the
younger years to near the importance as Freud.
Childhood
Ages 1 to 5
The development of speech and improved communication is key in this stage of development.
Juvenile
Ages 6 to 8
The main focus as a juvenile is the need for playmates and the beginning of healthy socialization
Preadolescence
Ages 9 to 12
During this stage, the child’s ability to form a close relationship with a peer is the major focus.  This
relationship will later assist the child in feeling worthy and likable.  Without this ability, forming the intimate
relationships in late adolescence and adulthood will be difficult.
Early Adolescence
Ages 13 to 17
The onset of puberty changes this need for friendship to a need for sexual expression.  Self worth will often
become synonymous with sexual attractiveness and acceptance by opposite sex peers.
Late Adolescence
Ages 18 to 22 or 23
The need for friendship and need for sexual expression get combined during late adolescence.  In this stage a
long term relationship becomes the primary focus.  Conflicts between parental control and self-expression are
commonplace and the overuse of selective inattention in previous stages can result in a skewed perception of
the self and the world.
Adulthood
Ages 23 on
The struggles of adulthood include financial security, career, and family.  With success during previous stages,
especially those in the adolescent years, adult relationships and much needed socialization become more easy to
attain.  Without a solid background, interpersonal conflicts that result in anxiety become more commonplace.
Theory of Psychosocial Development-
Erikson’s

Erik Erikson was an ego psychologist who developed one of the most popular and influential theories of
development. While his theory was impacted by psychoanalyst Sigmund Freud's work, Erikson's theory
centered on psychosocial development rather than psychosexual development.

The stages that make up his theory are as follows

 Stage 1: Trust vs. Mistrust

 Stage 2: Autonomy vs. Shame and Doubt
 Stage 3: Initiative vs. Guilt
 Stage 4: Industry vs. Inferiority
 Stage 5: Identity vs. Confusion
 Stage 6: Intimacy vs. Isolation
 Stage 7: Generativity vs. Stagnation
 Stage 8: Integrity vs. Despair

Let's take a closer look at the background and different stages that make up Erikson's psychosocial theory.

Trust vs. Mistrust

From birth to 12 months of age, infants must learn that adults can be trusted. This occurs when adults meet a
child’s basic needs for survival. Infants are dependent upon their caregivers, so caregivers who are responsive
and sensitive to their infant’s needs help their baby to develop a sense of trust; their baby will see the world as a
safe, predictable place. Unresponsive caregivers who do not meet their baby’s needs can engender feelings
of anxiety, fear, and mistrust; their baby may see the world as unpredictable. If infants are treated cruelly or
their needs are not met appropriately, they will likely grow up with a sense of mistrust for people in the world.

Autonomy vs. Shame/Doubt

As toddlers (ages 1–3 years) begin to explore their world, they learn that they can control their actions and act
on their environment to get results. They begin to show clear preferences for certain elements of the
environment, such as food, toys, and clothing. A toddler’s main task is to resolve the issue of autonomy vs.
shame and doubt by working to establish independence. This is the “me do it” stage. For example, we might
observe a budding sense of autonomy in a 2-year-old child who wants to choose her clothes and dress herself.
Although her outfits might not be appropriate for the situation, her input in such basic decisions has an effect on
her sense of independence. If denied the opportunity to act on her environment, she may begin to doubt her
abilities, which could lead to low self-esteem and feelings of shame.

Initiative vs. Guilt

Once children reach the preschool stage (ages 3–6 years), they are capable of initiating activities and asserting
control over their world through social interactions and play. According to Erikson, preschool children must
resolve the task of initiative vs. guilt.By learning to plan and achieve goals while interacting with others,
preschool children can master this task. Initiative, a sense of ambition and responsibility, occurs when parents
allow a child to explore within limits and then support the child’s choice. These children will develop self-
confidence and feel a sense of purpose. Those who are unsuccessful at this stage—with their initiative misfiring
or stifled by over-controlling parents—may develop feelings of guilt.

Industry vs. Inferiority

During the elementary school stage (ages 6–12), children face the task of industry vs. inferiority. Children begin
to compare themselves with their peers to see how they measure up. They either develop a sense of pride and
accomplishment in their schoolwork, sports, social activities, and family life, or they feel inferior and
inadequate because they feel that they don’t measure up. If children do not learn to get along with others or
have negative experiences at home or with peers, an inferiority complex might develop into adolescence and
adulthood.

Identity vs. Role Confusion

In adolescence (ages 12–18), children face the task of identity vs. role confusion. According to Erikson, an
adolescent’s main task is developing a sense of self. Adolescents struggle with questions such as “Who am I?”
and “What do I want to do with my life?” Along the way, most adolescents try on many different selves to see
which ones fit; they explore various roles and ideas, set goals, and attempt to discover their “adult” selves.
Adolescents who are successful at this stage have a strong sense of identity and are able to remain true to their
beliefs and values in the face of problems and other people’s perspectives. When adolescents are apathetic, do
not make a conscious search for identity, or are pressured to conform to their parents’ ideas for the future, they
may develop a weak sense of self and experience role confusion. They will be unsure of their identity and
confused about the future. Teenagers who struggle to adopt a positive role will likely struggle to “find”
themselves as adults.

Intimacy vs. Isolation

People in early adulthood (20s through early 40s) are concerned with intimacy vs. isolation. After we have
developed a sense of self in adolescence, we are ready to share our life with others. However, if other stages
have not been successfully resolved, young adults may have trouble developing and maintaining successful
relationships with others. Erikson said that we must have a strong sense of self before we can develop
successful intimate relationships. Adults who do not develop a positive self-concept in adolescence may
experience feelings of loneliness and emotional isolation.

Generativity vs. Stagnation

When people reach their 40s, they enter the time known as middle adulthood, which extends to the mid-60s.
The social task of middle adulthood is generativity vs. stagnation. Generativity involves finding your life’s
work and contributing to the development of others through activities such as volunteering, mentoring, and
raising children. During this stage, middle-aged adults begin contributing to the next generation, often through
childbirth and caring for others; they also engage in meaningful and productive work which contributes
positively to society. Those who do not master this task may experience stagnation and feel as though they are
not leaving a mark on the world in a meaningful way; they may have little connection with others and little
interest in productivity and self-improvement.

Integrity vs. Despair

From the mid-60s to the end of life, we are in the period of development known as late adulthood. Erikson’s
task at this stage is called integrity vs. despair. He said that people in late adulthood reflect on their lives and
feel either a sense of satisfaction or a sense of failure. People who feel proud of their accomplishments feel a
sense of integrity, and they can look back on their lives with few regrets. However, people who are not
successful at this stage may feel as if their life has been wasted. They focus on what “would have,” “should
have,” and “could have” been. They face the end of their lives with feelings of bitterness, depression, and
despair.

OBJECT RELATION THEORY

Object relations theory is a psychodynamic theory within psychoanalytic psychology. The theory describes the
process of developing a psyche as one grows in relation to others in the environment. The theory suggests that
people relate to others and situations in their adult lives as shaped by family experiences during infancy. For
example, an adult who experienced neglect or abuse in infancy would expect similar behavior from others who
remind them of the neglectful or abusive person from their past (often a parent). The infant's images of people
and events turn into Objects in the subconscious that he or she carries into adulthood. People use these Objects
to understand their current relationships and predict people's behavior. The Self (or subject) relates to Objects in
the unconscious to make sense of the people and events around a person. "Objects" are usually internalized
images of one's mother or father. Objects can also be parts of a person, for instance an infant relating to the
breast. Objects may be both real or things in one's inner world (one's internalized image of others).[1] Object
relationships are initially formed during early interactions with primary care givers. Later experiences can
reshape these early patterns, but Objects often continue to exert a strong influence throughout life.[citation
needed] Otto Rank, Coiner of the term "pre-Oedipal," was the first to create a modern theory of "object
relations" in the late 1920s. It was later independently formulated by Ronald Fairbairn in 1952,[2] but the line
of thought being referred to first emerged in 1917, beginning with Ferenczi and, later, Rank. [3] Although first
formulated in the 1920s by Otto Rank, object relations theory was extended in the 1940s and 50s by British
psychologists Ronald Fairbairn, Melanie Klein, Donald Winnicott, Harry Guntrip, Scott Stuart, and others.
Objects are initially comprehended in the infant mind by their functions and are termed "part objects." [citation
needed] The breast that feeds the hungry infant is the "good breast." The hungry infant that finds no breast is in
relation to the "bad breast."[citation needed] Internal objects are formed by the patterns emerging in one's
repeated subjective experience of the care taking environment. These internalized images may or may not be
accurate representations of the actual, external others. With a "good enough" "facilitating environment" part
object functions eventually transform into a comprehension of whole objects. This corresponds with the ability
to tolerate ambiguity, to see that both the "good" and the "bad" breast are a part of the same "mummy."

Theory of cognitive development

Piaget's (1936) theory of cognitive development explains how a child constructs a mental model of the world.
He disagreed with the idea that intelligence was a fixed trait, and regarded cognitive development as a process
which occurs due to biological maturation and interaction with the environment.

Piaget was employed at the Binet Institute in the 1920s, where his job was to develop French versions of
questions on English intelligence tests. He became intrigued with the reasons children gave for their wrong
answers to the questions that required logical thinking. He believed that these incorrect answers revealed
important differences between the thinking of adults and children.

Piaget (1936) was the first psychologist to make a systematic study of cognitive development. His contributions
include a stage theory of child cognitive development, detailed observational studies of cognition in children,
and a series of simple but ingenious tests to reveal different cognitive abilities.

What Piaget wanted to do was not to measure how well children could count, spell or solve problems as a way
of grading their I.Q. What he was more interested in was the way in which fundamental concepts like the very
idea of number, time, quantity, causality, justice and so on emerged.
Before Piaget’s work, the common assumption in psychology was that children are merely less competent
thinkers than adults. Piaget showed that young children think in strikingly different ways compared to adults.

According to Piaget, children are born with a very basic mental structure (genetically inherited and evolved) on
which all subsequent learning and knowledge are based.

The goal of the theory is to explain the mechanisms and processes by which the infant, and then the child,
develops into an individual who can reason and think using hypotheses. 

To Piaget, cognitive development was a progressive reorganization of mental processes as a result of biological
maturation and environmental experience.

Children construct an understanding of the world around them, then experience discrepancies between what
they already know and what they discover in their environment.

Basic components to piaget’s cognitive theory

Schemas

(building blocks of knowledge).

Adaptation processes that enable the transition from one stage to another (equilibrium, assimilation, and 
accommodation).
Stages of Cognitive Development:

 sensorimotor,
 preoperational,
 concrete operational,
 formal operational

Schemas

 Imagine what it would be like if you did not have a mental model of your world. It would mean that you
would not be able to make so much use of information from your past experience or to plan future
actions.
 Schemas are the basic building blocks of such cognitive models, and enable us to form a mental
representation of the world. Piaget (1952, p. 7) defined a schema as:
 "a cohesive, repeatable action sequence possessing component actions that are tightly interconnected
and governed by a core meaning."
  In more simple terms Piaget called the schema the basic building block of intelligent behavior – a way
of organizing knowledge. Indeed, it is useful to think of schemas as “units” of knowledge, each relating
to one aspect of the world, including objects, actions, and abstract (i.e., theoretical) concepts.
 Wadsworth (2004) suggests that schemata (the plural of schema) be thought of as 'index cards' filed in
the brain, each one telling an individual how to react to incoming stimuli or information.
 When Piaget talked about the development of a person's mental processes, he was referring to increases
in the number and complexity of the schemata that a person had learned.
 When a child's existing schemas are capable of explaining what it can perceive around it, it is said to be
in a state of equilibrium, i.e., a state of cognitive (i.e., mental) balance.
 Piaget emphasized the importance of schemas in cognitive development and described how they were
developed or acquired. A schema can be defined as a set of linked mental representations of the world,
which we use both to understand and to respond to situations. The assumption is that we store these
mental representations and apply them when needed.
 For example, a person might have a schema about buying a meal in a restaurant. The schema is a stored
form of the pattern of behavior which includes looking at a menu, ordering food, eating it and paying the
bill. This is an example of a type of schema called a 'script.' Whenever they are in a restaurant, they
retrieve this schema from memory and apply it to the situation.
 The schemas Piaget described tend to be simpler than this - especially those used by infants. He
described how - as a child gets older - his or her schemas become more numerous and elaborate.
 Piaget believed that newborn babies have a small number of innate schemas - even before they have had
many opportunities to experience the world. These neonatal schemas are the cognitive structures
underlying innate reflexes. These reflexes are genetically programmed into us.
 For example, babies have a sucking reflex, which is triggered by something touching the baby's lips. A
baby will suck a nipple, a comforter (dummy), or a person's finger. Piaget, therefore, assumed that the
baby has a 'sucking schema.'
 Similarly, the grasping reflex which is elicited when something touches the palm of a baby's hand, or the
rooting reflex, in which a baby will turn its head towards something which touches its cheek, are innate
schemas. Shaking a rattle would be the combination of two schemas, grasping and shaking.

Assimilation and Accommodation

Jean Piaget (1952; see also Wadsworth, 2004) viewed intellectual growth as a process
of adaptation (adjustment) to the world. This happens through:

Assimilation
– Which is using an existing schema to deal with a new object or situation.

Accommodation

– This happens when the existing schema (knowledge) does not work, and needs to be changed to deal with a
new object or situation.

Equilibration

– This is the force which moves development along. Piaget believed that cognitive development did not
progress at a steady rate, but rather in leaps and bounds.

Equilibrium occurs when a child's schemas can deal with most new information through assimilation. However,
an unpleasant state of disequilibrium occurs when new information cannot be fitted into existing schemas
(assimilation).

Equilibration is the force which drives the learning process as we do not like to be frustrated and will seek to
restore balance by mastering the new challenge (accommodation). Once the new information is acquired the
process of assimilation with the new schema will continue until the next time we need to make an adjustment to
it.

Example of Assimilation

A 2-year-old child sees a man who is bald on top of his head and has long frizzy hair on the sides. To his
father’s horror, the toddler shouts “Clown, clown” (Siegler et al., 2003).

Example of Accommodation

In the “clown” incident, the boy’s father explained to his son that the man was not a clown and that even though
his hair was like a clown’s, he wasn’t wearing a funny costume and wasn’t doing silly things to make people
laugh.

With this new knowledge, the boy was able to change his schema of “clown” and make this idea fit better to a
standard concept of “clown”.

Piaget's 4 Stages of Cognitive Development

Piaget proposed four stages of cognitive development which reflect the increasing sophistication of children's
thought:
1. Sensorimotor stage (birth to age 2)

2. Preoperational stage (from age 2 to age 7)

3. Concrete operational stage (from age 7 to age 11)

4. Formal operational stage (age 11+ - adolescence and adulthood).

Each child goes through the stages in the same order, and child development is determined by biological
maturation and interaction with the environment.

Sensorimotor stage

The main achievement during this stage is Object Permanence - knowing that an object still exists, even if it is
hidden.

It requires the ability to form a mental representation (i.e., a schema) of the object.

Preoperational stage

During this stage, young children can think about things symbolically. This is the ability to make one thing - a
word or an object - stand for something other than itself.

Thinking is still egocentric, and the infant has difficulty taking the viewpoint of others.

Concrete operational stage

Piaget considered the concrete stage a major turning point in the child's cognitive development because it marks
the beginning of logical or operational thought.

This means the child can work things out internally in their head (rather than physically try things out in the real
world).

Children can conserve number (age 6), mass (age 7), and weight (age 9). Conservation is the understanding that
something stays the same in quantity even though its appearance changes.

Formal operational stage

The formal operational stage begins at approximately age eleven and lasts into adulthood. During this time,
people develop the ability to think about abstract concepts, and logically test hypotheses.

theory of moral development

Lawrence Kohlberg (1958) agreed with Piaget's (1932) theory of moral development in principle but wanted to
develop his ideas further. 
He used Piaget’s storytelling technique to tell people stories involving moral dilemmas.  In each case, he
presented a choice to be considered, for example, between the rights of some authority and the needs of some
deserving individual who is being unfairly treated.

Kohlberg’s stages of moral development

Kohlberg identified three levels of moral reasoning: pre-conventional, conventional, and post-conventional.
Each level is associated with increasingly complex stages of moral development.

Level 1: Preconventional

Throughout the preconventional level, a child’s sense of morality is externally controlled. Children accept and
believe the rules of authority figures, such as parents and teachers.  A child with pre-conventional morality has
not yet adopted or internalized society’s conventions regarding what is right or wrong, but instead focuses
largely on external consequences that certain actions may bring.

Stage 1: Obedience-and-Punishment Orientation

Stage 1 focuses on the child’s desire to obey rules and avoid being punished. For example, an action is
perceived as morally wrong because the perpetrator is punished; the worse the punishment for the act is, the
more “bad” the act is perceived to be.

Stage 2: Instrumental Orientation

Stage 2 expresses the “what’s in it for me?” position, in which right behavior is defined by whatever the
individual believes to be in their best interest. Stage two reasoning shows a limited interest in the needs of
others, only to the point where it might further the individual’s own interests. As a result, concern for others is
not based on loyalty or intrinsic respect, but rather a “you scratch my back, and I’ll scratch yours” mentality.
An example would be when a child is asked by his parents to do a chore. The child asks “what’s in it for me?”
and the parents offer the child an incentive by giving him an allowance.

Level 2: Conventional

Throughout the conventional level, a child’s sense of morality is tied to personal and societal relationships.
Children continue to accept the rules of authority figures, but this is now due to their belief that this is necessary
to ensure positive relationships and societal order. Adherence to rules and conventions is somewhat rigid during
these stages, and a rule’s appropriateness or fairness is seldom questioned.
Stage 3: Good Boy, Nice Girl Orientation

In stage 3, children want the approval of others and act in ways to avoid disapproval. Emphasis is placed on
good behavior and people being “nice” to others.

Stage 4: Law-and-Order Orientation

In stage 4, the child blindly accepts rules and convention because of their importance in maintaining a
functioning society. Rules are seen as being the same for everyone, and obeying rules by doing what one is
“supposed” to do is seen as valuable and important. Moral reasoning in stage four is beyond the need for
individual approval exhibited in stage three. If one person violates a law, perhaps everyone would—thus there is
an obligation and a duty to uphold laws and rules. Most active members of society remain at stage four, where
morality is still predominantly dictated by an outside force.

Level 3: Postconventional

Throughout the postconventional level, a person’s sense of morality is defined in terms of more abstract
principles and values. People now believe that some laws are unjust and should be changed or eliminated. This
level is marked by a growing realization that individuals are separate entities from society and that individuals
may disobey rules inconsistent with their own principles. Post-conventional moralists live by their
own ethical principles—principles that typically include such basic human rights as life, liberty, and justice—
and view rules as useful but changeable mechanisms, rather than absolute dictates that must be obeyed without
question. Because post-conventional individuals elevate their own moral evaluation of a situation over social
conventions, their behavior, especially at stage six, can sometimes be confused with that of those at the pre-
conventional level. Some theorists have speculated that many people may never reach this level of abstract
moral reasoning.

Stage 5: Social-Contract Orientation

In stage 5, the world is viewed as holding different opinions, rights, and values. Such perspectives should be
mutually respected as unique to each person or community. Laws are regarded as social contracts rather than
rigid edicts. Those that do not promote the general welfare should be changed when necessary to meet the
greatest good for the greatest number of people. This is achieved through majority decision and inevitable
compromise. Democratic government is theoretically based on stage five reasoning.

Peplau's Developmental Stages of the Nurse-Client Relationship

Orientation Phase

The orientation phase is initiated by the nurse. This is the phase during which the nurse and the patient become
acquainted, and set the tone for their relationship, which will ultimately be patient centered. During this stage, it
is important that a professional relationship is established, as opposed to a social relationship. This includes
clarifying that the patient is the center of the relationship, and that all interactions are, and will be centered
around helping the patient. This phase is usually progressed through during a highly impressionable phase in the
nurse-client relationship, because the orientation phase occurs shortly after admission to a hospital, when the
client is becoming accustomed to a new environment and new people. The nurse begins to know the patient as a
unique individual, and the patient should sense that the nurse is genuinely interested in them. Trust begins to
develop, and the client begins to understand their role, the nurse's role, and the parameters and boundaries of
their relationship.

Identification Phase

The client begins to identify problems to be worked on within relationship. The goal of the nurse is to help the
patient to recognize his/her own interdependent/participation role and promote responsibility for self.

Exploitation Phase / Working Phase

During the Working Phase, the nurse and the patient work to achieve the patient's full potential, and meet their
goals for the relationship. A sign that the transition from the orientation phase to the working phase has been
made, is if the patient can approach the nurse as a resource, instead of feeling a social obligation to the nurse
(Peplau, 1997). The client fully trusts the nurse, and makes full use of the nurse's services and professional
abilities. The nurse and the patient work towards discharge and termination goal.

Resolution Phase/Termination Phase

The termination phase of the nurse client relationship occurs after the current goals for the client have been met.
The nurse and the client summarize and end their relationship. One of the key aspects of a nurse-client
relationship, as opposed to a social relationship, is that it is temporary, and often of short duration (Peplau,
1997). In a more long term relationship, termination can commonly occur when a patient is discharged from a
hospital setting, or a patient dies. In more short term relationships, such as a clinic visit, an emergency room
visit, or a health bus vaccination visit, the termination occurs when the patient leaves, and the relationship is
usually less complex. However, in most situations, the relationship should terminate once the client has
established increased self-reliance to deal with their own problems.