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Tfnmod6relevantheoriesin Nursing Practice
Tfnmod6relevantheoriesin Nursing Practice
Maslow's hierarchy of needs is a theory by Abraham Maslow, which puts forward that people
are motivated by five basic categories of needs: physiological, safety, love, esteem, and self-
actualization.
Physiological
These refer to basic physical needs like drinking when thirsty or eating when hungry. According
to Maslow, some of these needs involve our efforts to meet the body’s need for homeostasis;
that is, maintaining consistent levels in different bodily systems (for example, maintaining a
body temperature of 98.6°)
Maslow considered physiological needs to be the most essential of our needs. If someone is
lacking in more than one need, they’re likely to try to meet these physiological needs first. For
example, if someone is extremely hungry, it’s hard to focus on anything else besides food.
Another example of a physiological need would be the need for adequate sleep.
Safety
Once people’s physiological requirements are met, the next need that arises is a safe
environment. Our safety needs are apparent even early in childhood, as children have a need
for safe and predictable environments and typically react with fear or anxiety when these are
not met. Maslow pointed out that in adults living in developed nations, safety needs are more
apparent in emergency situations (e.g. war and disasters), but this need can also explain why
we tend to prefer the familiar or why we do things like purchase insurance and contribute to a
savings account.
According to Maslow, the next need in the hierarchy involves feeling loved and accepted. This
need includes both romantic relationships as well as ties to friends and family members. It also
includes our need to feel that we belong to a social group. Importantly, this need encompasses
both feeling loved and feeling love towards others.
Since Maslow’s time, researchers have continued to explore how love and belonging needs
impact well-being. For example, having social connections is related to better physical health
and, conversely, feeling isolated (i.e. having unmet belonging needs) has negative
consequences for health and well-being.
Esteem
Our esteem needs involve the desire to feel good about ourselves. According to Maslow,
esteem needs include two components. The first involves feeling self-confidence and feeling
good about oneself. The second component involves feeling valued by others; that is, feeling
that our achievements and contributions have been recognized by other people. When people’s
esteem needs are met, they feel confident and see their contributions and achievements as
valuable and important. However, when their esteem needs are not met, they may experience
what psychologist Alfred Adler called “feelings of inferiority.”
Self-Actualization
Self-actualization refers to feeling fulfilled, or feeling that we are living up to our potential. One
unique feature of self-actualization is that it looks different for everyone. For one person, self-
actualization might involve helping others; for another person, it might involve achievements in
an artistic or creative field. Essentially, self-actualization means feeling that we are doing what
we believe we are meant to do. According to Maslow, achieving self-actualization is relatively
rare, and his examples of famous self-actualized individuals include Abraham Lincoln, Albert
Einstein, and Mother Teresa.
2. Transactional Analysis
Child represents all brain recordings of internal events (feelings or emotions) that
are directly linked to the external events observed by the child during the first five
years of life. Examples of events recorded in this state may include:
I feel happy when Mom hugs me.
Dad’s late night movie was very scary.
I feel sad when Mom is sad.
Adult, the final ego state, is the period in which a child develops the capacity to
perceive and understand situations that are different from what is observed
(Parent) or felt (Child). The Adult serves as a data processing center that utilizes
information from all three ego states in order to arrive at a decision. One important
role of the Adult is to validate data which is stored in the Parent:
I see that Suzie’s house was burnt down. Mom was right—I should not play with
matches.
Systems theory was proposed in the 1940's by the biologist Ludwig von Bertalanffy
and furthered by Ross Ashby (1964). Von Bertalanffy was reacting against both
reductionism and attempting to revive the unity of science. He is considered to be the
founder and principal author of general systems theory.
If one were to analyze current notions and fashionable catchwords, he would find
“systems” high on the list.
von Bertalanffy (1968) wrote that a system is a complex of interacting elements and
that they are open to, and interact with their environments. In addition, they can
acquire qualitatively new properties through emergence, thus they are in a continual
evolution. When referring to systems, it also generally means that they are self-
regulating (they self-correct through feedback).
The concept of system, though it seems to be intrinsic to human thinking, has been extensively
employed and developed over the last few decades, due in a large measure to contributions
made by Karl Ludwig von Bertalanffy (1901-1972), a Viennese professor of biology. He worked
to identify structural, behavioral and developmental features common to particular classes of
living organisms. One approach was to look over the empirical universe and pick out certain
general phenomena which are found in many different disciplines, and to seek to build up
general theoretical models relevant to these phenomena, e.g., growth, homeostasis, evolution.
Another approach was to arrange the empirical fields in a hierarchy of complexity of
organization of their basic 'individuality' or units of behavior, and to try to develop a level of
abstraction appropriate to each. Examples are generalizations on the levels of cells, simple
organs, open self-maintaining organisms, small groups of organisms, society and the universe.
The latter approach implies a hierarchical "systems of systems" view of the world.
Bertalanffy's ideas were developed into a General Systems Theory. He defined a general system
as any theoretical system of interest to more than one discipline. This new vision of reality is
based on awareness of the essential interrelatedness and inter-dependence of all phenomena -
physical, biological, psychological, social and cultural. It transcends orthodox disciplinary and
conceptual boundaries.
The systems view looks at the world in terms of relationships and integration. Systems are
integrated wholes whose properties cannot be reduced to those of smaller units. Instead of
concentrating on basic building blocks or substances, the systems approach emphasizes the
principles of organization. Every organism, from the smallest bacterium through the range of
plant, animals and human beings - plus the family, society and the planet as whole - is an
integrated whole and thus a living system.
Another important aspect of systems is their intrinsically dynamic nature. Their forms are not
rigid structures but are flexible yet stable manifestations of underlying processes. Systems
thinking is process thinking; form becomes associated with process, interrelation with
interaction, and opposites are unified through oscillation.
Human survival, in Bertalanffy's view, was the paramount purpose for cultivating the
uncommon sense of General Systems Theory. Our civilization is experiencing enormous
difficulties due to lack of ethical, ethological and ecological criteria in the manifestation of
human affairs, which are currently only concerned with the management of larger profits for a
small minority of privileged humans. Bertalanffy believed that the need for a general systems
consciousness was a matter of life and death, not just for ourselves but also for all future
generations on our planet. He advocated a new global morality, an ethos which does not center
on individual values alone, but on the adaptation of Mankind, as a global system, to its new
environment... "We are dealing with emergent realities; no longer with isolated groups of men,
but with a systemically interdependent global community."
Unfreezing
Before you can cook a meal that has been frozen, you need to defrost or thaw it out. The same
can be said of change. Before a change can be implemented, it must go through the initial step
of unfreezing. Because many people will naturally resist change, the goal during the unfreezing
stage is to create an awareness of how the status quo, or current level of acceptability, is
hindering the organization in some way. Old behaviors, ways of thinking, processes, people and
organizational structures must all be carefully examined to show employees how necessary a
change is for the organization to create or maintain a competitive advantage in the
marketplace. Communication is especially important during the unfreezing stage so that
employees can become informed about the imminent change, the logic behind it and how it
will benefit each employee. The idea is that the more we know about a change and the more
we feel it is necessary and urgent, the more motivated we are to accept the change.
Changing
Now that the people are 'unfrozen' they can begin to move. Lewin recognized that change is a
process where the organization must transition or move into this new state of being.
This changing step, also referred to as 'transitioning' or 'moving,' is marked by the
implementation of the change. This is when the change becomes real. It's also, consequently,
the time that most people struggle with the new reality. It is a time marked with uncertainty
and fear, making it the hardest step to overcome. During the changing step people begin to
learn the new behaviors, processes and ways of thinking. The more prepared they are for this
step, the easier it is to complete. For this reason, education, communication, support and time
are critical for employees as they become familiar with the change. Again, change is a process
that must be carefully planned and executed. Throughout this process, employees should be
reminded of the reasons for the change and how it will benefit them once fully implemented.
Refreezing
When the changes are taking shape and people have embraced the new ways of working, the
organization is ready to refreeze. The outward signs of the refreeze are a stable organization
chart, consistent job descriptions, and so on. The refreeze stage also needs to help people and
the organization internalize or institutionalize the changes. This means making sure that the
changes are used all the time, and that they are incorporated into everyday business. With a
new sense of stability, employees feel confident and comfortable with the new ways of
working.
Each stage in Erikson's theory builds on the preceding stages and paves the way for following
periods of development. In each stage, Erikson believed people experience a conflict that
serves as a turning point in development.2
In Erikson's view, these conflicts are centered on either developing a psychological quality or
failing to develop that quality. During these times, the potential for personal growth is high but
so is the potential for failure.
If people successfully deal with the conflict, they emerge from the stage with psychological
strengths that will serve them well for the rest of their lives. 3 If they fail to deal effectively with
these conflicts, they may not develop the essential skills needed for a strong sense of self.
Erikson also believed that a sense of competence motivates behaviors and actions. Each stage
in Erikson's theory is concerned with becoming competent in an area of life.
If the stage is handled well, the person will feel a sense of mastery, which is sometimes referred
to as ego strength or ego quality. If the stage is managed poorly, the person will emerge with a
sense of inadequacy in that aspect of development.
At this point in development, the child is utterly dependent upon adult caregivers for
everything they need to survive including food, love, warmth, safety, and nurturing. If a
caregiver fails to provide adequate care and love, the child will come to feel that they cannot
trust or depend upon the adults in their life.
Outcomes
If a child successfully develops trust, the child will feel safe and secure in the world. 2 Caregivers
who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in
the children under their care. Failure to develop trust will result in fear and a belief that the
world is inconsistent and unpredictable.
During the first stage of psychosocial development, children develop a sense of trust when
caregivers provide reliability, care, and affection. A lack of this will lead to mistrust.
No child is going to develop a sense of 100% trust or 100% doubt. Erikson believed that
successful development was all about striking a balance between the two opposing sides. When
this happens, children acquire hope, which Erikson described as an openness to experience
tempered by some wariness that danger may be present.
Subsequent work by researchers including John Bowlby and Mary Ainsworth demonstrated the
importance of trust in forming healthy attachments during childhood and adulthood.
The second stage of Erikson's theory of psychosocial development takes place during early
childhood and is focused on children developing a greater sense of personal control.
At this point in development, children are just starting to gain a little independence. They are
starting to perform basic actions on their own and making simple decisions about what they
prefer. By allowing kids to make choices and gain control, parents and caregivers can help
children develop a sense of autonomy.2
Potty Training
The essential theme of this stage is that children need to develop a sense of personal control
over physical skills and a sense of independence. Potty training plays an important role in
helping children develop this sense of autonomy.
Like Freud, Erikson believed that toilet training was a vital part of this process. However,
Erikson's reasoning was quite different than that of Freud's. Erikson believed that learning to
control one's bodily functions leads to a feeling of control and a sense of independence. Other
important events include gaining more control over food choices, toy preferences, and clothing
selection.
Outcomes
Children who struggle and who are shamed for their accidents may be left without a sense of
personal control. Success during this stage of psychosocial development leads to feelings of
autonomy; failure results in feelings of shame and doubt.
Finding Balance
Children who successfully complete this stage feel secure and confident, while those who do
not are left with a sense of inadequacy and self-doubt. Erikson believed that achieving a
balance between autonomy and shame and doubt would lead to will, which is the belief that
children can act with intention, within reason and limits.
The third stage of psychosocial development takes place during the preschool years. At this
point in psychosocial development, children begin to assert their power and control over the
world through directing play and other social interactions.
Children who are successful at this stage feel capable and able to lead others. Those who fail to
acquire these skills are left with a sense of guilt, self-doubt, and lack of initiative.
Outcomes
The major theme of the third stage of psychosocial development is that children need to begin
asserting control and power over the environment. Success in this stage leads to a sense of
purpose. Children who try to exert too much power experience disapproval, resulting in a sense
of guilt.
When an ideal balance of individual initiative and a willingness to work with others is achieved,
the ego quality known as purpose emerges.
This Is How Children Develop a Sense of Initiative
Stage 4: Industry vs. Inferiority
The fourth psychosocial stage takes place during the early school years from approximately
ages 5 to 11. Through social interactions, children begin to develop a sense of pride in their
accomplishments and abilities.
Children need to cope with new social and academic demands. Success leads to a sense of
competence, while failure results in feelings of inferiority.
Outcomes
Children who are encouraged and commended by parents and teachers develop a feeling of
competence and belief in their skills. Those who receive little or no encouragement from
parents, teachers, or peers will doubt their abilities to be successful.
Successfully finding a balance at this stage of psychosocial development leads to the strength
known as competence, in which children develop a belief in their abilities to handle the tasks
set before them.
How Children Develop a Sense of Industry vs Inferiority
The fifth psychosocial stage takes place during the often turbulent teenage years. This stage
plays an essential role in developing a sense of personal identity which will continue to
influence behavior and development for the rest of a person's life. Teens need to develop a
sense of self and personal identity. Success leads to an ability to stay true to yourself, while
failure leads to role confusion and a weak sense of self.
During adolescence, children explore their independence and develop a sense of self. 2 Those
who receive proper encouragement and reinforcement through personal exploration will
emerge from this stage with a strong sense of self and feelings of independence and control.
Those who remain unsure of their beliefs and desires will feel insecure and confused about
themselves and the future.
What Is Identity?
When psychologists talk about identity, they are referring to all of the beliefs, ideals, and values
that help shape and guide a person's behavior. Completing this stage successfully leads
to fidelity, which Erikson described as an ability to live by society's standards and expectations.
While Erikson believed that each stage of psychosocial development was important, he placed a
particular emphasis on the development of ego identity. Ego identity is the conscious sense of
self that we develop through social interaction and becomes a central focus during the identity
versus confusion stage of psychosocial development.
According to Erikson, our ego identity constantly changes due to new experiences and
information we acquire in our daily interactions with others. As we have new experiences, we
also take on challenges that can help or hinder the development of identity.
Our personal identity gives each of us an integrated and cohesive sense of self that endures
through our lives. Our sense of personal identity is shaped by our experiences and interactions
with others, and it is this identity that helps guide our actions, beliefs, and behaviors as we age.
Young adults need to form intimate, loving relationships with other people. Success leads to
strong relationships, while failure results in loneliness and isolation. This stage covers the
period of early adulthood when people are exploring personal relationships.2
Erikson believed it was vital that people develop close, committed relationships with other
people. Those who are successful at this step will form relationships that are enduring and
secure.
Remember that each step builds on skills learned in previous steps. Erikson believed that a
strong sense of personal identity was important for developing intimate relationships. Studies
have demonstrated that those with a poor sense of self tend to have less committed
relationships and are more likely to struggler with emotional isolation, loneliness, and
depression.
Successful resolution of this stage results in the virtue known as love. It is marked by the ability
to form lasting, meaningful relationships with other people.
Intimacy vs. Isolation: Forming Intimate Relationships With Others
Adults need to create or nurture things that will outlast them, often by having children or
creating a positive change that benefits other people. Success leads to feelings of usefulness
and accomplishment, while failure results in shallow involvement in the world.
During adulthood, we continue to build our lives, focusing on our career and family. Those who
are successful during this phase will feel that they are contributing to the world by being active
in their home and community.2 Those who fail to attain this skill will feel unproductive and
uninvolved in the world.
Care is the virtue achieved when this stage is handled successfully. Being proud of your
accomplishments, watching your children grow into adults, and developing a sense of unity
with your life partner are important accomplishments of this stage.
The Differences and Characteristics of Generativity and Stagnation
The final psychosocial stage occurs during old age and is focused on reflecting back on life. 2 At
this point in development, people look back on the events of their lives and determine if they
are happy with the life that they lived or if they regret the things they did or didn't do.
Erikson's theory differed from many others because it addressed development throughout the
entire lifespan, including old age. Older adults need to look back on life and feel a sense of
fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret,
bitterness, and despair.
At this stage, people reflect back on the events of their lives and take stock. Those who look
back on a life they feel was well-lived will feel satisfied and ready to face the end of their lives
with a sense of peace. Those who look back and only feel regret will instead feel fearful that
their lives will end without accomplishing the things they feel they should have.
Outcomes
Those who are unsuccessful during this stage will feel that their life has been wasted and may
experience many regrets. The person will be left with feelings of bitterness and despair.
Those who feel proud of their accomplishments will feel a sense of integrity. Successfully
completing this phase means looking back with few regrets and a general feeling of satisfaction.
These individuals will attain wisdom, even when confronting death.
An Overview of Integrity vs. Despair
Erikson's theory also has its limitations and attracts valid criticisms. What kinds of experiences
are necessary to successfully complete each stage? How does a person move from one stage to
the next?
Criticism
One major weakness of psychosocial theory is that the exact mechanisms for resolving conflicts
and moving from one stage to the next are not well described or developed. The theory fails to
detail exactly what type of experiences are necessary at each stage in order to successfully
resolve the conflicts and move to the next stage.
6. Kohlberg's stages of moral development
Kohlberg's stages of moral development are planes of moral adequacy conceived by Lawrence
Kohlberg to explain the development of moral reasoning. Created while studying psychology at
the University of Chicago, the theory was inspired by the work of Jean Piaget and a fascination
with children's reactions to moral dilemmas. He wrote his doctoral dissertation at the university
in 1958, outlining what are now known as his stages of moral development.
This theory holds that moral reasoning, which is the basis for ethical behaviour, has six
identifiable developmental stages. He followed the development of moral judgment beyond
the ages originally studied by Piaget, who claimed that logic and morality develop
through constructive stages. Kohlberg expanded considerably on this groundwork, determining
that the process of moral development was principally concerned with justice and that its
development continued throughout the lifespan, even spawning dialogue of philosophical
implications of his research.
Kohlberg used stories about moral dilemmas in his studies, and was interested in how people
would justify their actions if they were put in a similar moral crux. He would then categorize
and classify evoked responses into one of six distinct stages. These six stages where broken into
three levels: pre-conventional, conventional and post-conventional. His theory is based on
constructive developmental stages; each stage and level is more adequate at responding to
moral dilemmas than the last.
Stages
Kohlberg's six stages were grouped into three levels: pre-conventional, conventional, and post-
conventional. Following Piaget's constructivist requirements for a stage model (see his theory
of cognitive development), it is extremely rare to regress backward in stages. Even still, no one
functions at their highest stage at all times. It is also not possible to 'jump' stages; each stage
provides a new yet necessary perspective, and is more comprehensive, differentiated, and
integrated than its predecessors.
Level 1 (Pre-Conventional)
( Principled conscience)
Pre-Conventional
The pre-conventional level of moral reasoning is especially common
in children, although adults can also exhibit this level of reasoning.
Reasoners in the pre-conventional level judge the morality of an action
by its direct consequences. The pre-conventional level consists of the
first and second stages of moral development, and are purely
concerned with the self in an egocentric manner.
Conventional
The conventional level of moral reasoning is typical of adolescents and
adults. Persons who reason in a conventional way judge the morality of
actions by comparing these actions to societal views and expectations.
The conventional level consists of the third and fourth stages of moral
development.
In Stage three, the self enters society by filling social roles. Individuals
are receptive of approval or disapproval from other people as it
reflects society's accordance with the perceived role. They try to be
a good boy or good girl to live up to these expectations, having learned
that there is inherent value in doing so. Stage three reasoning may
judge the morality of an action by evaluating its consequences in terms
of a person's relationships, which now begin to include things like
respect, gratitude and the ' golden rule'. Desire to
maintain rules and authority exists only to further support these
stereotypical social roles. The intentions of actions play a more
significant role in reasoning at this stage; 'they mean well...'.
Post-Conventional
The post-conventional level, also known as the principled level,
consists of stages five and six of moral development. Realization that
individuals are separate entities from society now becomes salient.
One's own perspective should be viewed before the society's. It is due
to this 'nature of self before others' that the post-conventional level,
especially stage six, is sometimes mistaken for pre-conventional
behaviors.
Formal elements
Heinz dilemma
A dilemma that Kohlberg used in his original research was the
druggist's dilemma: Heinz Steals the Drug In Europe.
A woman was near death from a special kind of cancer. There was one
drug that the doctors thought might save her. It was a form
of radium that a druggist in the same town had recently discovered.
The drug was expensive to make, but the druggist was charging ten
times what the drug cost him to produce. He paid $200 for the radium
and charged $2,000 for a small dose of the drug. The sick woman's
husband, Heinz, went to everyone he knew to borrow the money, but
he could only get together about $ 1,000 which is half of what it cost.
He told the druggist that his wife was dying and asked him to sell it
cheaper or let him pay later. But the druggist said: "No, I discovered
the drug and I'm going to make money from it." So Heinz got desperate
and broke into the man's store to steal the drug-for his wife.
Should Heinz have broken into the laboratory to steal the drug for his
wife? Why or why not?
Stage three (conformity): Heinz should steal the medicine because his
wife expects it; he wants to be a good husband. Or: Heinz should not
steal the drug because stealing is bad and he is not a criminal; he tried
to do everything he could without breaking the law, you cannot blame
him.
Stage five (human rights): Heinz should steal the medicine because
everyone has a right to choose life, regardless of the law. Or: Heinz
should not steal the medicine because the scientist has a right to fair
compensation. Even if his wife is sick it does not make his actions right.
Stage six (universal human ethics): Heinz should steal the medicine,
because saving a human life is a more fundamental value than the
property rights of another person. Or: Heinz should not steal the
medicine, because others may need the medicine just as badly, and
their lives are equally significant.