Growth and Development

The Family and The Individual
Across the Life Span

The Family

Definition: Basic unit of society
What does "family" mean to you ?
How should "family" be defined ?
Who defines "family" ?

Role of Nurse:

Be aware of personal values and beliefs.
Accept & respect differences.

Trends: Different family forms have unique concerns/issues

Roles of the Family: Functional vs Dysfunctional
Physical/emotional support and security
Provide Physical Health:
Significant influence on health beliefs and perceptions of health status
: transmission of religious, social, and cultural values

Family Assessment

Data Collection
Stage of development
Sociological factors
Use of Critical Processes
Goal Setting
Conflict Resolution
Resource Utilization

Health beliefs/Practices: Lifestyle
Medical History: Genogram/Risk Factors
Data Analysis
: The health of the family is more than the sum of each memberís health
Assess family as a unit
Consider strengths and weaknesses
Formulate nursing diagnoses
e.g. Family Processes Altered related to

Growth and Development

Critical Concepts

Growth: Quantitative aspects; e.g. Height
Qualitative aspects; e.g. Social behavior/skills
Integrated process: Combines quantitative & qualitative aspects
Critical Periods:
Necessary Factors: Sensory stimulation, timing, & readiness

General Principles

Orderly sequence & direction
Complex, predictable patterns
Unique to individuals
Periods of conflict & adaptation with tasks, change, & challenge
Influenced by heredity, temperament, and environment
Theories: Erikson (Psychosocial)
Goal: Self-actualization

Life Span Considerations

Developmental perspective is organized and systematic
Developmental assessment/needs are critical to plan of care
Nurse must understand normal growth and development
Nurse assesses cognitive development, physical growth, and psychosocial development

Developmental Stages

Infancy: First year of life

Erikson: Trust vs Mistrust
Rapid, steady physical growth: length, weight, head circumference, nutrition, reflexive to purposeful behavior
Caregiver-child bonding based on personal interactions
Environment provides sensory stimulation for learning

Toddler: 1-3 years

Erikson: Autonomy vs Shame & Doubt
Psychomotor skills: Gross to fine
Egocentric, no right/wrong
Wants independence but fears separation
Health Concerns: Accidents (ingestion of poison, drowning), ear and upper respiratory infections

Preschooler: 3-6 years

Erikson: Initiative vs Guilt
lower physical growth with increased muscle coordination
Concrete thinking: Ask "why?"
Fear bodily harm
Pretend play: Parallel to cooperative
Health Concerns
: Accidents, speech disorders

School-age: 6-11 years

Erikson: Industry vs Inferiority
Fine tuning of body systems
Intense cognitive development
Moving toward abstract thinking
Developing problem solving: "What if?"
Independence: same sex peers
Developing moral code: Right/Wrong
Health Concerns
: Accidents, learning disabilities, infectious disease, cancer

Adolescence: 13 - 21 years

Erikson: Identity vs Role Confusion
Sexual maturation: Primary and secondary sex characteristics
Logical decision-making
Internalized moral code
Need close peer relationships
Health Concerns
: Accidents, substance abuse, pregnancy, STDs, eating disorders

Young Adult: Late teens - mid 30s

Erikson: Intimacy vs Isolation
Physical growth completed
Focus on personal & social tasks: career choice, social and intimate relationships, self-concept, adult relationship with family
Health Concerns
: Accidents, violence, STDs, job & family stress, unhealthy lifestyle practices (ETOH, smoking).
Need to learn & practice SBE, TSE

Middle Adult: 35 - 65 years

Erikson: Generativity vs Stagnation
Changes in physical state: Menopause, andropause
Focus on family, work, aging parents (Sandwich Generation)
Health Concerns
: Health screening (mammograms, PSA), stress reduction, healthy lifestyle strategies, adjustment to life transitions

Older Adult: 65 and older

Old-old and Frail-old: 75 and older
Elite-old: 85 and older
Erikson: Ego integrity vs Despair
Ageism: a concern for nurses
Aging is a normal, healthy process that begins at birth
System-wide physical changes
Cognitive changes due to illness not aging
Numerous lifestyle changes
Remain independent, accept aging, transitions, and loss.
Reminiscence/life review (Storytelling)
Exercise, nutrition, sensory stimulation
Health Concerns
: Chronic illness, medications, depression, ETOH abuse, elder abuse


When a nurse encounters another Something happens
What occurs is never a neutral event
A pulse taken Words exchanged
A touch A healing moment
Two persons are never the same