DEVELOPMENTAL THEORIES

Developmental theories provide a framework for examining, describing, and

appreciating human development. Developmental theories are also important in
helping nurses assess and treat a person’s response to an illness. Understanding
the specific task or need of each developmental stage guides caregivers in planning
appropriate individualized care for patients. Human development is a dynamic and
complex process that cannot be explained by only one theory.

Psychoanalytical/Psychosocial Theory
- Theories of psychoanalytical/psychosocial development describe human
development from the perspectives of personality, thinking, and behavior .
Psychoanalytical theory explains development as primarily unconscious and
influenced by emotion. Psychoanalytical theorists maintain that these
unconscious drives influence development through universal stages
experienced by all individuals (Berger, 2007).

A. Freud’s Psychoanalytical Model of Personality Development

- Sigmund Frued states that individuals go through five stages of psychosexual
development and that each stage is characterized by sexual pleasure in parts of the
body: the mouth, the anus, and the genitals. Freud believed that adult personality
is the result of how an individual resolved conflicts between these sources of
pleasure and the mandates of reality.

Stage 5: Genital (Puberty Through Adulthood).

-In this final stage sexual urges reawaken and are directed to an individual outside
the family circle. Unresolved prior conflicts surface during adolescence. Once the
individual resolves conflicts, he or she is then capable of having a mature adult
sexual relationship.
- Freud believed that the components of the human personality develop in stages
and regulate behavior. These components are the id, the ego, and the superego.
The id (i.e., basic instinctual impulses driven to achieve pleasure) is the most
primitive part of the personality and originates in the infant. The ego represents the
reality component, mediating conflicts between the environment and the forces of the
id.
- The ego helps people judge reality accurately, regulate impulses, and make good
decisions. The third component, the superego, performs regulating, restraining, and
prohibiting actions.
-Often referred to as the conscience, the superego is influenced by the standards of
outside social forces (e.g., parent or teacher). Some of Freud’s critics contend that
he based his analysis of personality development on biological determinants and
ignored the influence of culture and experience. Other critics think that Freud’s basic
assumptions such as the Oedipus complex are not applicable across different
cultures. Psychoanalysts today believe that the role of conscious thought is much
greater than Freud imagined (Santrock, 2008).

B. Erikson’s Theory of Psychosocial Development

- Freud had a strong influence on his psychoanalytical followers, including Erik
Erikson (19021994), who constructed a theory of development that differed from
Freud’s in two major views.
-Erikson maintained that development occurred throughout the life span and that it
focused on psychosocial stages rather than psychosexual stages.
- According to Erikson’s theory of psychosocial development, individuals need to
accomplish a particular task before successfully mastering the stage and
progressing to the next one. Each task is framed with opposing conflicts, and tasks
once mastered are challenged and tested again during new situations or at times of
conflict (Hockenberry and Wilson, 2011). Erikson’s eight stages of life.

Identity versus Role Confusion (Puberty).

-Dramatic physiological changes associated with sexual maturation mark this stage.
There is a marked preoccupation with appearance and body image.
-This stage, in which identity development begins with the goal of achieving some
perspective or direction, answers the question, “Who am I?” Acquiring a sense of
identity is essential for making adult decisions such as choice of a vocation or
marriage partner.
- Each adolescent move in his or her unique way into society as an interdependent
member. There are also new social demands, opportunities, and conflicts that relate
to the emergent identity and separation from family.
-Erikson held that successful mastery of this stage resulted in devotion and fidelity to
others and to their own ideals (Hockenberry and Wilson, 2011). The nurse provides
education and anticipatory guidance for the parent about the changes and
challenges to the adolescent.
- Nurses also help hospitalized adolescents deal with their illness by giving them
enough information to allow them to make decisions about their treatment plan.
Cognitive Developmental Theory
-focus on an individual’s unconscious thought and emotions; cognitive theories
stress how people learn to think and make sense of their world.
-As with personality development, cognitive theorists have explored both childhood
and adulthood. Some of the theories highlight qualitative changes in thinking; others
expand to include social, cultural, and behavioral dimensions.

C. Piaget’s Theory of Cognitive Development

-Jean Piaget (18961980) was most interested in the development of children’s
intellectual organization: how they think, reason, and perceive the world.
-Piaget’s theory of cognitive development includes four periods that are related to
age and demonstrate specific categories of knowing and understanding.
-He built his theory on years of observing children as they explored, manipulated,
and tried to make sense out of the world in which they lived. Piaget believed that
individuals move from one stage to the other seeking.

Period IV: Formal Operations (11 Years to Adulthood).

-The transition from concrete to formal operational thinking occurs in stages during
which there is a prevalence of egocentric thought.
-This egocentricity leads adolescents to demonstrate feelings and behaviors
characterized by selfconsciousness, a belief that their actions and appearance are
constantly being scrutinized (an “imaginary audience”), that their thoughts and
feelings are unique (the “personal fable”), and that they are invulnerable.
-These feelings of invulnerability frequently lead to risktaking behaviors, especially in
early adolescence.
-As adolescents share experiences with peers, they learn that many of their thoughts
and feelings are shared by almost everyone, helping them to know that they are not
so different.
-As adolescents mature, their thinking moves to abstract and theoretical subjects.
They have the capacity to reason with respect to possibilities. For Piaget this stage
marked the end of cognitive development.

D. Theory of Moral Development (Lawrence Kohlberg’s)

- Kohlberg’s theory of moral development expands on Piaget’s cognitive theory.
Kohlberg interviewed children, adolescents, and eventually adults and found that
moral reasoning develops in stages.
-From an examination of responses to a series of moral dilemmas, he identified six
stages of moral development under three levels (Kohlberg, 1981).

Level II: Conventional Reasoning

-At level II, conventional reasoning, the person sees moral reasoning based on his or
her own personal internalization of societal and others’ expectations. A person wants
to fulfill the expectations of the family, group, or nation and also develop a loyalty to
and actively maintain, support, and justify the order.
-Moral decision making at this level moves from, “What’s in it for me?” to “How will it
affect my relationships with others?” Emphasis now is on social rules and a
community centered approach.
-Nurses observe this when family members make endoflife decisions for their loved
ones. Individual members often struggle with this type of moral dilemma. Grief
support involves an understanding of the level of moral decision making of each
family member.
-Stage 3: Good Boy–Nice Girl Orientation. The individual wants to win approval
and maintain the expectations of one’s immediate group. “Being good” is important
and defined as having good motives, showing concern for others, and keeping
mutual relationships through trust, loyalty, respect, and gratitude.
-One earns approval by “being nice.” For example, a person in this stage stays after
school and does odd jobs to win the teacher’s approval.
Stage 4: Society-Maintaining Orientation.
-Individuals expand their focus from a relationship with others to societal
concernsduring stage 4. Moral decisions take into account societal perspectives.
Right behavior is doing one’s duty, showing respect for authority, and maintaining
the social order. Adolescents choose not to attend a party where they know beer will
be served, not because they are afraid of getting caught, but because they know that
it is not right. Level III: Postconventional Reasoning. The person finds a balance
between basic human rights and obligations and societal rules and regulations in the
level of postconventional reasoning. Individuals move away from moral decisions
based on authority or conformity to groups to define their own moral values and
principles. Individuals at this stage start to look at what an ideal society would be
like. Moral principles and ideals come into prominence at this level.
Stage 5: Social Contract Orientation
- Having reached stage 5, an individual follows the societal law but recognizes the
possibility of changing the law to improve society. The individual also recognizes that
different social groups have different values but believes that all rational people
would agree on basic rights such as liberty and life.
- Individuals at this stage make more of an independent effort to determine what
society should value rather than what the society as a group would value, as would
occur in stage 4. The United States Constitution is based on this morality.
Stage 6: Universal Ethical Principle Orientation
-Stage 6 defines “right” by the decision of conscience in accord with selfchosen
ethical principles. These principles are abstract, like the Golden Rule, and appeal to
logical comprehensiveness, universality, and consistency. For example, the principle
of justice requires the individual to treat everyone in an impartial manner, respecting
the basic dignity of all people, and guides the individual to base decisions on an
equal respect for all. Civil disobedience is one way to distinguish Stage 5 from Stage
6. Stage 5 emphasizes the basic rights, the democratic process, and following laws
without question, whereas stage 6 defines the principles by which agreements will be
most just. For example, a person in stage 5 follows a law, even if it is not fair to a
certain racial group. An individual in stage 6 may not follow a law if it does not seem
just to the racial group. For example, Martin Luther King believed that although we
need laws and democratic processes, people who are committed to justice have an
obligation to disobey unjust laws and accept the penalties for disobeying these laws.

Developmental Theory
E. Robert J. Havighurst(1972)
-believed that living and growing are based on learning, and that a person must
continuously learn to adjust to changing societal conditions.
-He described learned behaviors as developmental tasks that occur at certain
periods in life. Successful achievement leads to happiness and success in later
tasks, whereas unsuccessful achievement leads to unhappiness, societal
disapproval, and difficulty in later tasks.
-The developmental tasks arise from maturation, personal motives, and values that
determine occupational and family choices and civic responsibility. The
developmental tasks, by age, follow.
ADOLESCENCE Developmental tasks for adolescence include:
• Accepting one’s body and using it effectively
• Achieving a masculine or feminine gender role
• Achieving emotional independence from parents and other adults
• Preparing for a career
• Preparing for marriage and family life
• Desiring and achieving socially responsible behavior
• Acquiring an ethical system as a guide to behavior
F. Roger Gould (1978)
- studied men and women between the ages of 16 and 60 years, labeling the central
theme for the adult years as “transformation,” with specific beliefs and developmental
phases.
AGES 18 TO 22
-During the young adult years, individuals typically struggle with leaving their
parents’world and challenging false assumptions from their child-like consciousness
(e.g., “Only my parents can guarantee my safety.”).
-However, these assumptions are replaced with new false assumptions, such as
“Rewards will come automatically if we do what we are supposed to do.”

Theory of Faith Development:

G.James Fowler Fowler (1981)
-postulated a developmental theory of the spiritual identity of humans, based on work
by Piaget, Kohlberg, and Erikson. Fowler describes faith as follows: Faith is not
always religious in its content or context.
-Faith is a person’s or group’s way of moving into the force field of life. It is our way
of finding coherence in and giving meaning to the multiple forces and relations that
make up our lives. Faith is a person’s way of seeing him or herself in relation to
others against a background of shared meaning.

Stage 3—Synthetic–Conventional Faith Synthetic

–conventional faith is the characteristic stage for many adolescents. As the person
experiences increasing demands from work, school, family, and peers, the basis for
identity becomes more complex.
-The person has an emerging ideology but has not closely examined it until now. The
person begins to question life-guiding values or religious practices in an attempt to
stabilize his or her own identity.