NCM 107 Care of Child and Adolescence (Well Clients)

Module 2: Theories of Growth and Development

I.
INTRODUCTION

Developmental theories provide a framework for examining, describing, and appreciating human
development. 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. This module presents biophysical,
psychoanalytical/psychosocial, cognitive, and moral developmental theories.

II.
OBJECTIVES

1. Discuss factors influencing growth and development.

2. Describe biophysical developmental theories.
3. Describe and compare the psychoanalytical/psychosocial theories proposed by Freud and Erikson.
4. Describe Piaget’s theory of cognitive development.
5. Apply developmental theories when planning interventions in the care of patients throughout the
life span.
6. Discuss nursing implications for the application of developmental principles to patient care

III.
VOCABULARY LIST

For your better understanding of the lesson , here is the list of words and their meanings. Read and understand them carefully.

1. Id- The id is that part of the psyche that is the source of instinctive energy, impulses and drives.
2. Ego- reality principle
3. Superego- moral principle
4. Oedipus complex- The Oedipal complex occurs during the Phallic stage of development (ages 3-6) in
which the source of libido (life force) is concentrated in the erogenous zones of the child's body
5. Castration Fear-describe a boy’s fear of loss of or damage to the genital organ as punishment for
incestuous wishes toward the mother and murderous fantasies toward the rival father.
6. Electra Complex-The Electra complex is a term used to describe the female version of the Oedipus
complex. It involves a girl, aged between 3 and 6, becoming unconsciously sexually attached to her
father and increasingly hostile toward her mother.
 7. Penis Envy-refers to the reaction of the female/young girl during development when she realizes that
she does not possess a penis.
8. Ego Ideal- rewards the person with feelings of wellbeing and pride when person conforms to the
demands of the superego.
9. Conscience- punishes the person with guilt feelings when the person deviates from the demands of
superego

IV.
PRE - TEST

Instruction: Encircle the answer that best corresponds to your answer.

1. Nine-year-old Brian has a difficult time making friends at school and being chosen to play on the team.
He also has trouble completing his homework and, as a result, receives little positive feedback from
his parents or teacher. According to Erikson’s theory, failure at this stage of development results in:
a) A sense of guilt.
b) A poor sense of self.
c) Feelings of inferiority.
d) Mistrust.

2. The nurse teaches parents how to have their children learn impulse control and cooperative
behaviors. This would be during which of Erickson’s stages of development?
a) Trust versus mistrust
b) Initiative versus guilt
c) Industry versus inferiority
d) Autonomy versus sense of shame and doubt

3. When Ryan was 3 months old, he had a toy train; when his view of the train was blocked, he did not
search for it. Now that he is 9 months old, he looks for it, reflecting the presence of:
a) Object permanence.
b) Sensorimotor play.
c) Schemata.
d) Magical thinking

4. Place the following stages of Freud’s psychosexual development in the proper order by age
progression.
a) Oedipal
b) Latency
c) Oral
d) Genital
e) Anal
 5. According to Piaget’s cognitive theory, a 12-year-old child is most likely to engage in which of the
following activities?
a) Using building blocks to determine how houses are constructed
b) Writing a story about a clown who wants to leave the circus
c) Drawing pictures of a family using stick figures
d) Writing an essay about patriotism

V.
LEARNING ACTIVITIES

Sigmund Freud

Sigmund Freud

Personality Development (Freud)

Structures of the Mind

1. Id- The id is that part of the psyche that is the source of instinctive energy, impulses and drives.
(Unconscious mind)

▪ Based on the pleasure principle, it directs behavior towards self-gratification.

▪ Demand to take care of needs immediately.
▪ The ID is also not in contact with reality. It only knows that it wants what it wants right away
regardless of the present circumstances or the consequences.
▪ When needs are not satisfied, such as the need for food, it begins to demand more and more
attention, until there comes a point where the person can’t think of anything else.

2. Ego- reality principle

▪ In charge with harnessing the ID libidinal energy in making sure that these urges are expressed in
acceptable way.
▪ It is focused on helping the person achieve their goal in ways that are realistic and acceptable.

3. Superego- moral principle

▪ It keeps tract of the rewards and punishment meted out by two of the most influential objects in
the world of the child mom and dad.
 ▪ It is not completed until about seven years old. In some people, it is never completed.
▪ The superego develops last as the person incorporates standards, restrictions, taboos, ideals
imposed by parents and other individuals whom the child associates with to guide behavior,
thoughts and feelings.

The id, ego, and superego are the 3 systems of personality. These psychological processes follow
different operating principles. In a mature and well-adjusted personality, they work together as
a team under the leadership of the ego.

Composed of:
✔ Ego Ideal- rewards the person with feelings of wellbeing and pride when person conforms to the
demands of the superego.
✔ Conscience- punishes the person with guilt feelings when the person deviates from the demands
of superego

Human Mind Model

1. Conscious- aware of here and now, in contact with reality. It functions only when the person is
awake.

2. Subconscious- contains the partially forgotten memories that can be recalled at will. The
preconscious serve as the watchman by preventing unacceptable and anxiety producing memories
from reaching the unconscious or awareness.

3. Unconscious- the largest part of personality that is often compared to the hidden part of the iceberg
under the water that contains memories that are forgotten and cannot be brought back to
consciousness at will.
▪ Even though the memories are forgotten the accompanying feelings continue to affect the person
and influence his behavior.

(Psychosexual Theory) 1856-1939

1. Oral Stage (birth to 1 year)

▪ during infancy the major source of pleasure-seeking is focused around the oral activities such as
sucking, biting, chewing, and vocalizing
▪ Behavior: Period of complete dependence
▪ Task is to distinguish self from mother
▪ The child develops body image or self-concept from the response of other.

2. Anal Stage (1 to 3 years)

▪ the area of interest is the anus as sphincter muscles develop and they expel or retain fecal material
▪ the climate of toilet training is important aspect here for the development of personalities
▪ Behavior: control of holding on and letting go.
 ▪ Develops concept of power, punishment, ambivalence, concern with cleanliness and being dirty.
▪ Breaks symbolic ties with the mother; as the ties are broken, the child learns independence.

3. Phallic Stage (3 to 6 years)

▪ the genitals become an interesting part of the body and are very sensitive
▪ differences in sexes is noticed and there is curiosity in differences
▪ this is the time which the controversial issues such as Oedipus and Electra complexes, castration,
penis envy is centered

✓ Oedipus complex- The Oedipal complex occurs during the Phallic stage of development (ages 3-6)
in which the source of libido (life force) is concentrated in the erogenous zones of the child's
body (Freud, 1905).
▪ During this stage, children experience an unconscious feeling of desire for their opposite-
sex parent and jealousy and envy toward their same-sex parent.

✓ Castration Fear-describe a boy’s fear of loss of or damage to the genital organ as punishment for
incestuous wishes toward the mother and murderous fantasies toward the rival father.

✓ Electra Complex-The Electra complex is a term used to describe the female version of the Oedipus
complex. It involves a girl, aged between 3 and 6, becoming unconsciously sexually attached to
her father and increasingly hostile toward her mother.

✓ Penis Envy-refers to the reaction of the female/young girl during development when she realizes
that she does not possess a penis.

▪ Behavior: Masturbation, touching of the genitals.

4. Latency Period (6 to 12 years)

▪ children elaborate on previously acquired skills
▪ physical and psychic energy are directed towards new knowledge and play.
▪ Behavior: sense of industry and mastery
▪ Learns control over aggressive and destructive impulses as the child conforms to rules and
restrictions.
▪ Acquires friends, is pre-occupied with peers of same sex.

5. Genital Stage (age 12 and over)

▪ begins with maturation of the reproductive organs.
▪ genital organs are the major source of sexual tensions and pleasures
▪ all energy is directed towards friendships with the hope of marriage and family
▪ Behavior: becomes independent of parents, responsible for self.
 ▪ Develops sexual identity, ability to love and work.

LEARNING ACTIVITY NO. 1

MECHANICS of the ACTIVITY

You are given a clinical scenario for this activity in which you will apply the PSYCHOSEXUAL THEORY of SIGMUND FREUD
Your answers should be written in a sentence form. Write as many as you can provided that you are able to explain your
thoughts very well.
You may write your answers in a writing pad and submit it online.

CRITICAL THINKING What Should You Do? The mother of a 4-year-old

child calls the clinic nurse and expresses concern because the child
has been masturbating. Using Freud’s psychosexual stages of
development, what should the nurse do to alleviate the mother’s
concerns?
Scoring Rubrics 15 pts
Criteria Points Points earned

1. Content 5 ______
2. Grammar, Usage and Mechanics 5 ______
3. Quality 5 ______

Erik Erikson

Psychosocial Development (Erikson)

▪ Erikson describes key conflicts or problems which must

be mastered during critical periods of personality development
▪ each psychosocial stage as two components – a favorable and unfavorable one
▪ no core conflict is ever mastered completely but is a recurrent problem throughout life
▪ there are eight stages in Erikson’s life-span but only five refer to children

According to Erikson’s theory of psychosocial development, each psychosocial crisis must be resolved
for the child or adult to progress emotionally. Unsuccessful resolution can leave the person
emotionally disabled

1. Trust vs. Mistrust (birth to 1 year) INFANCY

▪ establishment of trust dominates the first years of life and describes all the satisfying experiences
▪ it is the time of “getting” and “taking in” of all senses
▪ it exists only in relation to someone or something and therefore the maternal or mothering person
is essential to the development of trust
▪ mistrust develops when trust-promoting experiences are lacking and usually when basic needs are
not met
▪ the positive result of trust is FAITH AND OPTIMISM

2. Autonomy vs Shame and Doubt (1 to 3 years) TODDLER

▪ autonomy during the toddler stage is the time when the child wants to control their bodies,
themselves and their environment
▪ it corresponds to Freud’s anal stage during the sphincter muscle control
▪ independence is important
▪ their newly acquired skills are learned by watching others
▪ shame and doubt develop when they are forced to be dependent on others or when they are
criticized and made to feel small and self-conscious with their newly acquired skills
▪ favorable outcomes are SELF-CONTROL AND WILLPOWER

3. Initiative vs. Guilt (3 to 6 years) PRESCHOOLER

▪ characterized by vigorous, intrusive behavior, enterprise, and strong imagination
▪ exploration of their world brings them to undertake goals and activities which are contrary to their
parents
▪ if their imaginings and activities are considered bad, a sense of guilt can be produced
▪ lasting outcomes are DIRECTION AND PURPOSE

4. Industry vs. Inferiority (6 to 12 years) SCHOOL AGE

▪ children are not ready to be workers and producers
▪ they want to begin and complete tasks and activities
▪ achievement is very important during this stage
▪ cooperation and following the rules is paramount
▪ if too much is expected of them and they cannot achieve their goal – a feeling of inferiority is
developed
▪ the ego quality developed from sense of industry is COMPETENCE which is the free exercise of skill
and intelligence to complete a task

5. Identity vs Identity Confusion (12 to 18 years) PUBERTY or ADOLESCENCE

▪ characterized by rapid physical changes
▪ children become preoccupied with the way they look in the eyes of others
▪ struggle to fit into roles they play and the roles of their peers
▪ decision making regarding their future careers
▪ inability to solve core conflict leads to confusion
▪ successful mastery leads to DEVOTION AND FIDELITY
 Resolution of Crisis
Psychosocial
Age Crisis Task Successful Unsuccessful
Infancy (birth to Trust versus Attachment to Trust in persons; faith General difficulties relating to
18 mo mistrust the mother and hope about the persons effectively; suspicion;
environment and trust-fear conflict, fear of the
future future
Early childhood Autonomy Gaining some Sense of self-control Independence-fear conflict;
(18 mo to 3 yr) versus shame basic control and adequacy; severe feelings of self-doubt
and doubt over self and willpower
environment
Late childhood Initiative Becoming Ability to initiate Aggression-fear conflict; sense
(3-6 yr) versus guilt purposeful and one’s own activities; of inadequacy or guilt
directive sense of purpose
School age (6-12 Industry Developing Competence; ability Sense of inferiority; difficulty
yr) versus social, physical, to learn and work learning and working
inferiority and learning
skills
Adolescence (12- Identity Developing Sense of personal Confusion about who one is;
20 yr) versus role sense of identity identity submerged in
confusion identity relationships or group
memberships
Early adulthood Intimacy Establishing Ability to love deeply Emotional isolation,
(20-35 yr) versus intimate bonds and commit oneself egocentricity
isolation of love and
friendship
Middle Generativity Fulfilling life Ability to give and Self-absorption; inability to
adulthood (35-65 versus goals that care for others grow as a person
yr) stagnation involve family,
career, and
society
Later adulthood Integrity Looking back Sense of integrity and Dissatisfaction with life
(65 yr to death) versus despair over one’s life fulfillment
and accepting
its meaning

LEARNING ACTIVITY NO. 2

 MECHANICS of the ACTIVITY

You are given a clinical scenario for this activity in which you will apply the PSYCHOSOCIAL THEORY of ERIK ERICKSON
Your answers should be written in a sentence form. Write as many as you can provided that you are able to explain your
thoughts very well.
You may write your answers in a writing pad and submit it online.

CRITICAL THINKING What Should You Do? You have been assigned to care for Daniel Jackson, a 17-year-
old male who was in an automobile accident several days ago and sustained a fractured pelvis. He has had a
surgical repair and remains on bed rest. School is starting next month and he was scheduled to begin football
practice next week. During bedside report he refuses to make eye contact with the nursing staff or respond to
any questions to help direct his care. A. How will you incorporate your knowledge of adolescent development as
you establish priorities for his care? B. Thinking about Erikson’s theory, what psychosocial concerns do you
anticipate that Daniel might experience during his hospitalization and recovery period?

Scoring Rubrics 15 pts

Criteria Points Points earned

1. Content 5 ______
2. Grammar, Usage and Mechanics 5 ______
3. Quality 5 ______

Jean Piaget

Cognitive Development (Piaget)

▪ the term COGNITION refers to the process by which the developing individual becomes acquainted
with the world and the objects it contains, the way a person thinks
▪ the child is born with inherited intellectual ability but must interact with their environment
▪ the individual acquires the ability to think globally, to reason abstractly, to organize intellectual
functions into a higher order
▪ Jean Piaget (Swiss) felt that there were four major stages in the development of logical thinking
with each stage building on each other

1. Sensorimotor (birth to 2 years) INFANCY

▪ divided into six substages governed by sensations in which simple learning takes place
▪ there is a progression from reflex activity to simple repetitive behaviors to imitate behavior
▪ a “cause and effect” sense is developed
▪ problem solving is trial and error
▪ there is curiosity, experimentation and the enjoyment of self and they learn to differentiate
themselves from environment
▪ they realize that objects and people have PERMANENCE and they are present even if they do not
see them
▪ language develops at the end of this stage

2. Preoperational (2 to 7 years) TODDLER AND PRESCHOOLER

▪ the dominant characteristic of this stage is EGOCENTRICITY or the ability to put oneself in the place
of another
▪ children interpret objects in relationship to themselves and their own use
▪ their perspective is the only view and cannot see another point of view
▪ preoperational thinking is very concrete and tangible
▪ cannot make deductions or generalizations
▪ language and symbols are increasing in this stage
▪ in the latter stage they are becoming intuitive and are dealing with problems of weight, time size

3. Concrete Operations (7 to 11 years) SCHOOL AGE

▪ thinking is becoming logical and coherent
▪ children are able to organize, classify, sort and order which is used in problem solving
▪ they develop a new concept of permanence called CONSERVATION which means that they realize
that physical factors such as weight etc. change in appearance but they remain the same
▪ can deal with different aspects of life simultaneously
▪ problem solving is concrete and systematic
▪ reasoning is inductive
▪ other points of view now have relevance

4. Formal Operations (12 to 15 years) PUBERTY

▪ characterized by adaptability and flexibility
▪ thinking is abstract and conclusions can be drawn from observation
 ▪ hypotheses can be formulated and tested philosophy can be considered

LEARNING ACTIVITY NO. 3

MECHANICS of the ACTIVITY

Below are three circles with jumbled letters inside. The jumbled letters refer to some essential
terminologies related to COGNITIVE DEVELOPMENT by: Jean Piaget
Arrange these letters to come up with the correct answer.
If you think you got the correct term, write it in the space provided.

NOCONSERAVTI YTICIRTNECOGE ECNENAMREP

____________________ __________________ ____________________

 Lawrence Kohlberg

Moral Development: Lawrence Kohlberg

LAWRENCE KOHLBERG

A. Moral development

1. Moral development is a complicated process involving the acceptance of the values and rules of
society in a way that shapes behavior.
2. Moral development is classified in a series of levels and behaviors.
3. Moral development is sequential but people do not automatically go from 1 stage or level to the next
as they mature.
4. Stages or levels of moral development cannot be skipped.

B. Levels of moral development

Moral Development: Lawrence Kohlberg

Level One: Preconventional Morality

Stage 0 (Birth to 2 Years): Egocentric Judgment

✓ The infant has no awareness of right or wrong.
Stage 1(2to 4 Years): Punishment-Obedience Orientation
✓ At this stage, children cannot reason as mature members of society. Children view the world
in a selfish way, with no real understanding of right or wrong.
✓ The child obeys rules and demonstrates acceptable behavior to avoid punishment and to
avoid displeasing those who are in power, and because the child fears punishment from a
superior force, such as a parent.
✓ A toddler typically is at the first substage of the preconventional stage, involving punishment
and obedience orientation, in which the toddler makes judgments based on avoiding
punishment or obtaining a reward.
✓ Physical punishment and withholding privileges tend to give the toddler a negative view of
morals. Withdrawing love and affection as punishment leads to feelings of guilt in the
toddler.
✓ Appropriate discipline includes providing simple explanations of why certain behaviors are
unacceptable, praising appropriate behavior, and using distractions when the toddler is
headed for an unsafe action.
Stage 2 (4 to 7 Years): Instrumental Relativist Orientation
✓ The child conforms to rules to obtain rewards or have favors returned.
 ✓ The child’s moral standards are those of others, and the child observes them either to avoid
punishment or obtain rewards.
✓ A preschooler is in the preconventional stage of moral development. In this stage,
conscience emerges and the emphasis is on external control.

Level Two: Conventional Morality

✓ The child conforms to rules to please others. The child has increased awareness of others’
feelings. A concern for social order begins to emerge.
✓ A child views good behavior as that which those in authority will approve. If the behavior is
not acceptable, the child feels guilty.
Stage 3 (7 to 10 Years): Good Boy or Nice Girl Orientation
✓ Conformity occurs to avoid disapproval or dislike by others. This stage involves living up to
what is expected by individuals close to the child or what individuals generally expect of
others in their roles such as daughter, son, brother, sister, and friend.
✓ Being good is important and is interpreted as having good motives and showing concern
about others.
✓ Being good also means maintaining mutual relationships, such as trust, loyalty, respect, and
gratitude.
Stage 4 (10 to 12 Years): Law and Order Orientation
✓ The child has more concern with society as a whole.
✓ Emphasis is on obeying laws to maintain social order. Moral reasoning develops as the child
shifts the focus of living to society.
✓ The school-age child is at the conventional level of the conformity stage and has an increased
desire to please others. The child observes and to some extent internalizes the standards of
others.
✓ The child wants to be considered “good” by those individuals whose opinions matter to her
or him

Level Three: Postconventional Morality

✓ The individual focuses on individual rights and principles of conscience. The focus is on
concerns regarding what is best for all.
Stage 5: Social Contract and Legalistic Orientation
✓ The person is aware that others hold a variety of values and opinions and that most values
and rules are relative to the group.
✓ The adolescent in this stage gives and takes and does not expect to get something without
paying for it.
Stage 6: Universal Ethical Principles Orientation
✓ Conformity is based on universal principles of justice and occurs to avoid self-condemnation.
✓ This stage involves following self-chosen ethical principles.
✓ The development of the postconventional level of morality occurs in the adolescent at about
age 13 years, marked by the development of an individual conscience and a defined set of
moral values.
✓ The adolescent can now acknowledge a conflict between 2 socially accepted standards and
try to decide between them.
 ✓ Control of conduct is now internal in standards observed and in reasoning about right and
wrong.

VI.
PRACTICE TASKS

Comprehensive
Understanding

Let’s check your learning

1. Explain the 5 stages of Freud’s psychoanalytic model of personal development

a) Stage1: Oral______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________________________

b) Stage2: Anal______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________________________

c) Stage3: Phallic____________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________________________

d) Stage4: Latency__________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________________________
e) Stage 5: Genital__________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________________________

Match the following stages

of Erickson

1. _________ Trust vs mistrust a. 3-6 years

2. _________ Autonomy vs. shame b. birth to 1 year
3. _________ Initiative vs. guilt c. Puberty
4. _________ Industry vs. inferiority d. 1-3 years
5. _________ Identity vs. role confusion e. 6-11 year
6. _________ Intimacy vs. isolation f. middle age
7. _________ generativity vs. self-absorption g. young adult
8. _________ Integrity vs. despair h. old age

Identify the four periods

of Piaget’s theory of
cognitive development.

1. ____________________________________________________________________

2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________

Critical Thinking
 Select the appropriate answer and cite the rationale for choosing that particular answer.

1. According to Piaget, the school age child is in the third stage of cognitive development, which is
characterized by:

a) Concrete operations
b) Conventional operations
c) Post conventional thought
d) Identity vs. role confusion
Answer: ________
Rationale__________________________________________________________________________________
________________________________________________________________________________________

2. According to Erickson the developmental task of adolescence is:

a) Industry vs. inferiority

b) Identity vs, role confusion
c) Autonomy vs. shame and doubt
d) Role acceptance vs. role confusion
Answer______
Rationale__________________________________________________________________________________
_________________________________________________________________________________________

3. According to Erickson’s development theory, the primary developmental task of the middle year is
to:

a) Achieve intimacy
b) Achieve generativity
c) Establish a set of personal value
d) Establish a sense of personal identity
Answer______
Rationale__________________________________________________________________________________
__________________________________________________________________________________________

VII.
POST - TEST

Encircle the letter that best corresponds to your answer.

1. The clinic nurse is preparing to explain the concepts of Kohlberg’s theory of moral development with a
parent. The nurse should tell the parent that which factor motivates good and bad actions for the child
at the preconventional level?
1. Peer pressure
2. Social pressure
3. Parents’ behavior
4. Punishment and reward

2. The maternity nurse is providing instructions to a new mother regarding the psychosocial development
of the newborn infant. Using Erikson’s psychosocial development theory, the nurse instructs the
mother to take which measure?
1. Allow the newborn infant to signal a need.
2. Anticipate all needs of the newborn infant.
3. Attend to the newborn infant immediately when crying.
4. Avoid the newborn infant during the first 10 minutes of crying.

3. A nursing student is presenting a clinical conference to peers regarding Freud’s psychosexual stages of
development, specifically the anal stage. The student explains to the group that which characteristic
relates to this stage of development?
1. This stage is associated with toilet training.
2. This stage is characterized by the gratification of self.
3. This stage is characterized by a tapering off of conscious biological and sexual urges.
4. This stage is associated with pleasurable and conflicting feelings about the genital organs.

4. The nurse is describing Piaget’s cognitive developmental theory to pediatric nursing staff. The nurse
should tell that staff that which child behavior is characteristic of the formal operations stage?
1. The child has the ability to think abstractly.
2. The child begins to understand the environment.
3. The child is able to classify, order, and sort facts.
4. The child learns to think in terms of past, present, and future

5. The mother of an 8-year-old child tells the clinic nurse that she is concerned about the child because
the child seems to be more attentive to friends than anything else. Using Erikson’s psychosocial
development theory, the nurse should make which response?
1. “You need to be concerned.”
2. “You need to monitor the child’s behavior closely.
3.“At this age, the child is developing his own personality.”
4. “You need to provide more praise to the child to stop this behavior.”

VIII.
ASSIGNMENT / ADDITIONAL ACTIVITIES

1. Learning Insights/ Reflective Journaling:

 Well done!!! You did a great job.
Rest and relax a while then move on
to the next module. Good luck

References:

1. Gleason, K. and Devaskar, S. (2012). Avery’s Diseases of the Newborn. Philadelphia, PA: Saunders
2. Pillitteri, A. (2018). Maternal and Child Health Nursing: Care of the Childbearing and the Childrearing
Family. Philadelphia, PA: Lippincott Williams and Wilkins
3. Hockenberry,M. and Wilson, D (2013) Wong’s Essential of Pediatrics Nursing: Mosby
4. Delmar’s NCLEX-PN® Review, Second Edition (2013) Judith C. Miller, RN, MSN
5. Patricia A. Potter, RN, MSN, PhD, FAAN, Anne Griffin Perry, RN, EdD, FAAN Fundamentals of
Nursing 9th Edition