Chapter 7 Assessing Psychosocial, Cognitive, and Moral Development Concept

Chapter 7 Assessing Psychosocial, Cognitive, and Moral Development
CONCEPT
Having a basic understanding of the significant contributions made by theorists on

psychosexual, psychosocial, cognitive, and moral development of human is
fundamental to performing a holistic nursing assessment.
No single theory has been formulated to embrace all aspects of why humans behave,
think, or believe the way they do.
Psychosexual development
Sigmund Freud believed that we all had a conscious, preconscious, and unconscious level.
(Level of Awareness)
In the conscious we are aware of our mental process refers to whatever a person
is sensing, thinking about or experiencing at any given moment.
The preconscious involves information that, though not currently in our thoughts,
can be brought into consciousness involves all of a persons memories and stored
knowledge that can recalled and brought to the conscious level
Lastly, the unconscious includes mental processes we are unaware of largest and
most influential since this level corresponds to the socially unacceptable sexual
desires, shameful impulses, irrational wishes, as well as anxieties and fears.
He believed there is tension between the conscious and unconscious, because the conscious
tries to hold back what the unconscious tries to express. To explain this he developed three
personality structures: the id, ego, and superego.
The id, the most primitive of the three, functions according to the pleasure principle:
seek pleasure and avoid pain.
The superego plays the critical and moralizing role;
and the ego is the organized, realistic part that mediates between the desires of the
id and the superego.
Based on this, he proposed five universal stages of development, that each is

characterized by the erogenous zone that is the source of the child's psychosexual energy.
The first is the oral stage (0-1.5 years), which occurs from birth to 12 months of
age. During the oral stage "the libido is centered in a baby's mouth." The baby is
able to suck.
The second is the anal stage (1.5-3 years), from one to three years of age. During
the anal stage, the child defecates from the anus.
The third is the phallic stage (3-6 years), which occurs from three to five years of
age (most of a person's personality forms by this age).
GuidedLectureNotesHealthAssessment2016AATelles
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During the phallic stage, the child is aware of their sexual organs.
The fourth is the latency stage (6-11 years), which occurs from age five until
puberty. During the latency stage, the child's sexual interests are repressed.
Stage five is the genital stage (adolescence), which takes place from puberty
until adulthood. During the genital stage, puberty starts happening.
Stages of psychosocial development

Erik Erikson reinterpreted Freud's psychosexual stages by incorporating the social aspects of
it. He came up with eight stages, each of which has two crisis (a positive and a negative).
Infant: Stage one is trust versus mistrust, which occurs during infancy. (0-2
years)
Can I trust the world?
Toddler: Stage two is autonomy versus shame and doubt, which occurs during
early childhood. (2-4 years)
Is it Ok to be me?
Preschooler: Stage three is initiative versus guilt, which occurs during play age.
Is it ok for me to do, move and act?
School-ager: Stage four is industry versus inferiority, which occurs during school
age.
Can I make it in the world of people and things?
Adolescent: Stage five is identity versus Role confusion, which occurs during
adolescence.
Who am I, what can I be?
Young Adult: Stage six is intimacy versus isolation which occurs during young
adulthood.
Can I love?
Middle Adult: Stage seven is generativity versus stagnation which occurs during
adulthood.
Can I make my life count?
Older Adult: Lastly, stage eight is 'Ego integrity versus despair, which occurs in
old age.
Is it ok to have been me?
Each stage builds upon the successful completion of earlier stages. The challenges of stages
not successfully completed may be expected to reappear as problems in the future.
However, mastery of a stage is not required to advance to the next stage.
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Theories of cognitive development

Jean Piaget, a Swiss theorist, posited that children learn by actively constructing knowledge
through hands-on experience. He suggested that the adult's role in helping the child learn
was to provide appropriate materials that the child can interact with and use to construct.
Piaget believed that intellectual development takes place through a series of stages, which
he described in his theory on cognitive development. Each stage consists of steps the child
must master before moving to the next step. He believed that these stages are not separate
from one another, but rather that each stage builds on the previous one in a continuous
learning process.
He proposed four stages: sensorimotor, pre-operational, concrete operational,
and formal operational. Though he did not believe these stages occurred at any given
age, many studies have determined when these cognitive abilities should take place.
The four development stages are described in Piaget's theory as:
1. Sensorimotor stage: from birth to age 2.
Children experience the world through movement and senses (use five senses to
explore the world).
During the sensorimotor stage children are extremely egocentric, meaning they
cannot perceive the world from others viewpoints and explore using senses.
Is divided into Six Substages:
Substage 1 Simple reflexes is from birth to 1 month old. At this time infants use
reflexes such as rooting and sucking.
Substage 2 First habits and primary circular reactions is from 1 month to 4
months old. During this time infants learn to coordinate sensation and two types of
scheme (habit and circular reactions).
o A primary circular reaction is when the infant tries to reproduce an event
that happened by accident (ex: sucking thumb).
Substage 3 Secondary circular reactions, occurs when the infant is 4 to 8
months old. At this time they become aware of things beyond their own body; they
are more objects oriented. At this time they might accidentally shake a rattle and
continue to do it for sake of satisfaction.
Substage 4 Coordination of secondary circular reactions is from 8 months to
12 months old. During this stage they can do things intentionally. They can now
combine and recombine schemes and try to reach a goal (ex: use a stick to reach
something). They also understand object permanence during this stage. That is, they
understand that objects continue to exist even when they can't see them.
Substage 5 Tertiary circular reactions occurs from 12 months old to 18 months
old. During this stage infants explore new possibilities of objects; they try different
things to get different results.
Substage 6 Internalization they are 18 to 24 months old. During this stage they
shift to symbolic thinking.
2. Preoperational stage: from ages 2 to 5 (magical thinking predominates.
Acquisition of motor skills) Egocentricism begins strongly and then weakens. Children
cannot conserve or use logical thinking.
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3. Concrete operational stage: from ages 5 to 11 (children begin to think logically

but are very concrete in their thinking) Children can now conserve and think logically
but only with practical aids. They are no longer egocentric.
4. Formal operational stage: after age 11 (development of abstract reasoning).
Children develop abstract thought and can easily conserve and think logically in their
mind
Stages of moral development
Piaget claimed that logic and morality develop through constructive stages. Expanding on
Piaget's work, Lawrence Kohlberg determined that the process of moral development was
principally concerned with justice, and that it continued throughout the individual's lifetime.
He suggested three levels of moral reasoning: preconventional moral reasoning,
conventional moral reasoning, and postconventional moral reasoning.
Preconventional moral reasoning is typical of children and is characterized by reasoning
that is based on rewards and punishments associated with different courses of action.
What must I do to avoid punishment? What can I do to force my will upon others?
Whats in it for me? What must I do to avoid pain, gain pleasure?
Conventional moral reason occurs during late childhood and early adolescence and is
characterized by reasoning based on rules and conventions of society.
What must I do to be seen as good boy/girl?
What if everyone did that?
Postconventional moral reasoning is a stage during which the individual sees society's
rules and conventions as relative and subjective, rather than as authoritative.
What is the just thing to do given all the circumstances?
What will be the most good to the largest people?
What is justice for all?
HEALTH ASSESSMENT: COLELCTING SUBJECTIVE DATA: THE NURSING HEALTH

HISTORY
1.
2.
3.
4.
5.
Biographic data
History of present health concern
Personal health history
Family history
Lifestyle and health practices
ASSESSING DEVELOPMENTAL LEVEL: PSYCHOSOCIAL STATUS

Preparing the client
Maintain a caring, helping, trusting relationship with the client while assessing his or
her developmental level.
Refer to p.110 for the assessment procedure and suggested questions.
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What are the stages of psychosexual development according to Freud?

What are the stages of psychosexual development according to Freud?

What are the stages of psychosocial development according to Erikson?

What are the stages of psychosocial development according to Erikson?

Chapter 7 Assessing Psychosocial, Cognitive, and Moral Development

Having a basic understanding of the significant contributions made by theorists on

The superego plays the critical and moralizing role;

Based on this, he proposed five universal stages of development, that each is

Stages of psychosocial development

Can I trust the world?

Is it ok for me to do, move and act?

Can I make it in the world of people and things?

Who am I, what can I be?

Can I make my life count?

Is it ok to have been me?

Theories of cognitive development

3. Concrete operational stage: from ages 5 to 11 (children begin to think logically

Whats in it for me? What must I do to avoid pain, gain pleasure?

What must I do to be seen as good boy/girl?

What if everyone did that?

What is the just thing to do given all the circumstances?

What will be the most good to the largest people?

What is justice for all?

HEALTH ASSESSMENT: COLELCTING SUBJECTIVE DATA: THE NURSING HEALTH

ASSESSING DEVELOPMENTAL LEVEL: PSYCHOSOCIAL STATUS

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