Unit 7

Human Growth and Development

Pgs 167 - 190

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7:1 Life Stages

§  Growth & development is a lifelong process –  Begins at birth and ends at death

§  During an entire lifetime, individuals have needs that must be met

§  Health care workers need to be aware of the various stages and needs of the individual to provide quality health care

§  Life Stages – defined stages of growth and development throughout a person’s life

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Life Stages

§  Infancy: birth to 1 year §  Early childhood: 1-6 years §  Late childhood: 6-12 years §  Adolescence: 12-20 years §  Early adulthood: 20-40 years §  Middle adulthood: 40-65 years §  Late adulthood: 65 years and up

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Growth and Development Types §  As an individual passes through the life stages, four main

types of growth and development occur –  Physical: body growth

•  Height, weight, muscle and nerve development –  Mental: mind development

•  Problem solving, values, ethics, how to make judgments –  Emotional: feelings –  Social: interactions and relationships with others

§  In each life stage, all 4 types of growth must occur and the individual must develop certain tasks –  Tasks progress from simple to complex as the individual

ages (Example: sitting up à stand à walk à run)

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Erikson’s Stages of Psychosocial Development

§  Erik Erikson was a psychoanalyst who identified eight stages of psychosocial development

§  In each stage of development, an individual is met with certain conflicts and major life events –  A basic conflict or need must be met in each stage –  Erikson believes if the conflict is not resolved, the

individual will struggle with the same conflict later in life §  See Table 7-1 in text (pg 170)

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Infancy §  Age: birth to 1 year old, most dramatic changes in growth §  Physical development

–  Weight: Newborn (6 – 8 lbs), 12 months (21 – 24 lbs) –  Muscular and motor skills develop, teeth grow in

§  Mental development –  By 12 months, infants understand language and may use simple words

§  Emotional development –  Emotions and feelings develop: excitement, affection, anger, fear

§  Social development –  Recognize caregivers, may be shy with strangers

§  Infants are dependent on others for all needs

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Early Childhood §  Age: 1-6 years old §  Physical development

–  Weight: about 45 lbs by age 6 –  Legs and lower body grow faster than head, arms, chest –  Can eat adult foods; by 2-4 yrs should gain bladder and bowel control

§  Mental development –  Vocabulary and communication skills develop –  Memories develop and are used to make decisions

§  Emotional development –  Learn how to deal with new experiences, learn right/wrong, like routines

§  Social development –  Become attached to caregivers, enjoy playing with others but can be

very possessive §  Needs include food, rest, shelter, protection, security. Need

routine, order and consistency. Must be taught responsibility.

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Late Childhood (Preadolescence) §  Age: 6-12 years old §  Physical development

–  Weight: Typically increases 5 – 7 lbs a year –  Height: Typically increases 2 – 3 inches a year –  Develop complex motor-sensory coordination –  Baby teeth lost, permanent teeth grow in –  May start puberty towards end of late childhood (10 – 12 yrs)

§  Mental development –  Increases rapidly due to schooling –  Develop abstract concepts (loyalty, honesty, values, morals)

§  Emotional development –  Able to deal with emotions in a more effective manner

§  Social development –  Major changes during this stage

§  Needs include basic needs in addition to approval and acceptance

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Adolescence §  Age: 12-20 years old §  Physical development

–  Most dramatic changes occur in early period •  “Growth spurt” can cause rapid changes in height/weight

–  Puberty – secretion of sex hormones, development of secondary sexual characteristics

§  Mental development –  Increase knowledge and sharpen skills, develop decision making

process, values, morals

§  Emotional development –  Difficult during early period, towards end self-identity has been

established and teens may feel more comfortable with themselves

§  Social development –  Spend less time with family and more with peer groups

§  Needs include basic needs in addition to reassurance, support and understanding.

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Adolescence §  Many problems that develop in this stage can be

attributed to feelings of inadequacy or insecurity §  These life-long problems include:

–  Eating disorders •  Anorexia, Bulimia •  Often develop due to an excessive concern with appearance •  More common in females •  Treatments include therapy, nutrient supplements, hospitalization

–  Drug and alcohol abuse •  Development of dependence on drugs/alcohol, can lead to physical

and mental disorders •  Abuse often starts due to peer pressure; desire to escape anxieties,

emotional or psychological problems; hereditary traits •  Treatments include therapy, hospitalization, rehab

–  Suicide

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Suicide §  One of the leading causes of death in adolescents §  Permanent solution to temporary problem §  Reasons for suicide include depression, abuse, grief, feelings

of failure, influence from friends or family, lack of self-esteem §  Risks increased by family history, major loss or disappointment,

recent suicide of friend/family §  Most give warning signs such as sudden changes in behavior,

withdraw, depression, moodiness, chemical abuse, loss of interest in life, self-injury, saying goodbye to family/friends

§  Techniques to prevent suicide include counseling, support, therapy, hospitalization, rehab

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Early Adulthood §  Age: 20-40 years old §  Physical development

–  No major changes, prime childbearing age §  Mental development

–  Continues with education, independence, increasing personal responsibility

§  Emotional development –  Many emotional stresses from career, marriage, family, friends

§  Social development –  Involves moving away from peer groups and becoming

involved with a mate §  Needs same as adolescent

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Middle Adulthood (Middle Age)

§  Age: 40-65 years of age §  Physical development

–  Gray/thinning hair, wrinkles, decreased muscle tone and vision, hearing loss, weight gain, menopause (females)

§  Mental development –  Continues to increase

§  Emotional development –  Varies based on personal experiences and events

§  Social development –  Varies based on personal experiences and events

§  Needs remain the same

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Late Adulthood (Elderly, Senior citizen, Golden ager, and Retired citizen)

§  Age: 65 years of age and up §  Physical development

–  Declining, age spots on skin, thinning/loss of hair, thinning cartilage, decline in nerve functioning, memory loss, decrease lung capacity

§  Mental development –  Varies, some may develop Alzheimer’s disease

§  Emotional development –  Varies based on how person adjusts to changes occurring in their life

§  Social development –  Retirement may lead to loss of self-identity/esteem –  May have loss of relationships due to retirement/deaths

§  Needs now also include sense of belonging, self-esteem, financial security, social acceptance, love

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7:2 Death and Dying

§  Death is “the final stage of growth” §  Experienced by everyone §  Young people tend to ignore its existence §  Usually it is the elderly, who have lost others, who

begin to think about their own death §  Terminal illness – disease that is not curable, will

result in death –  Patients react differently to this diagnosis

•  Common reactions: fear, anxiety, acceptance

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Dr. Elizabeth Kübler-Ross

§  Dr. Elizabeth Kübler-Ross – researched the process of death and dying

§  Results of her research – Most medical personnel now believe patient

should be informed of approaching death – Patient should be left with some hope and know

they will not be left alone – Staff need to know what information is known by

patient and how the patient reacted

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Dr. Elizabeth Kübler-Ross

§  5 stages of grieving were identified §  Dying patients and their families/friends may

experience these stages §  Stages may not occur in order, may overlap or be

repeated §  Some patients may not progress through them

all, others may experience several stages at once

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Stages of Death and Dying

§  Denial – refuses to believe §  Anger – when no longer able to deny §  Bargaining – accepts death, but wants more time §  Depression – realizes death will come soon §  Acceptance – understands and accepts the fact

they are going to die

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Caring for the Dying Patient

§  Very challenging, but rewarding work §  Supportive care §  Health care worker must have self-awareness

– Need to come to terms with own personal feelings about death

§  Common to want to avoid feelings by avoiding dying patient

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Hospice Care

§  Palliative care for patients with less than 6 months to live – Palliative care – provide support and comfort

•  Pain management, counseling, holistic care

§  Offered in hospitals, medical centers, but most often in patient’s home

§  Philosophy: allow patient to die with dignity and comfort

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Right to Die

§  Health care workers must understand this issue –  Some people feel that an individual with a terminal illness

should be allowed to refuse measures to prolong their life §  Ethical issues must be addressed §  Allowing patients to die can cause conflict §  Specific actions to end life cannot be taken §  Laws allowing “right to die”

–  Allow adults to instruct doctors to withhold treatments •  Type of advanced directive

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Summary

§  Death is a part of life §  Health care workers will deal with death

and dying patients §  Must understand death and dying process

and think about needs of dying patients §  Then health care workers will be able

to provide the special care these individuals need

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7:3 Human Needs §  Needs: lack of something that is required or desired §  Needs exist from birth to death §  Needs influence our behavior §  Needs have a priority status §  When needs felt, individual is motivated to meet

these needs – Sense of satisfaction when needs met – Sense of frustration when needs not met

§  Several needs can be felt at the same time §  Different needs can have different levels of intensity

§  Maslow’s hierarchy of needs – Developed by Abraham Maslow, psychologist – 5 levels of needs – See Figure 7-13 in text (pg 180)

§  Lower needs must be met before the individual can try to meet the higher needs

Maslow's Hierarchy of Needs

§  Physiological needs – aka physical, basic – Food, water, oxygen, homeostasis, sleep, etc – Most are automatically controlled by body – Health care workers need to be aware of how

an illness interferes with the physiological needs

Maslow's Hierarchy of Needs

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Altered Physiological Needs §  Health care workers need to be aware of how

illness interferes with meeting physiological needs –  Must understand how treatments interact with body

§  Surgery or laboratory testing –  May not be able to eat or drink before/after test

§  Anxiety –  May cause changes in person’s behavior –  May interfere with sleep or bathroom habits

§  Medications –  May affect appetite, sleep, bathroom habits

§  Loss of vision or hearing –  May cause difficulties in communication

§  Safety – Free from anxiety, fear; feel secure – Need routines, allow to become familiar – Health care workers need to provide support

and allow patients to adapt and feel comfortable

§  Affection – Sense of belonging, friendship and love – Also involves gender identity, sexuality

Maslow's Hierarchy of Needs

§  Esteem – Self-respect, approval from others –  Illness may have a major effect on esteem

•  Health care workers need to provide supportive care, and allow the person to express their anger/fear

§  Self-realization – Obtain full potential; feel confident and secure with

self

Maslow's Hierarchy of Needs

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Methods for Satisfying Needs

§  Direct methods – Hard work – Set realistic goals – Evaluate situation – Cooperate with others

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Methods for Satisfying Needs

§  Indirect methods - Defense mechanisms –  Def: Unconscious act that helps a person deal with an

unpleasant situation –  Rationalization – use reasonable excuse for behavior in

order to avoid the real reason behind an action –  Projection – placing blame for own action on someone else –  Displacement – transferring feelings about one person to

someone else –  Compensation – substitution of one goal for another goal in

order to feel or achieve success –  Daydreaming – provides a means of escape if a person is

not satisfied with reality

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Methods for Satisfying Needs Indirect methods (continued)

– Repression – transfer of unacceptable of painful ideas to unconscious mind

– Suppression – similar to repression, but the individual is aware of the unacceptable feelings and refuses to deal with them

– Denial – not able to accept a frightening or shocking event as a reality

– Withdrawal – two types •  Withdraw by ceasing to communicate •  Withdraw by removing self from situation

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Summary

§  Be aware of own needs and patient’s needs §  More efficient and quality care can be provided

when know needs and understand motivations §  Better understanding of our behavior and that

of others

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7:4 Effective Communications §  Health care workers must be able to relate to

patients, family, coworkers, and others §  Communication - exchange of information,

thoughts, ideas, and feelings –  Written – communication through written correspondence –  Verbal – communication through spoken words –  Nonverbal – communication through body language,

facial expressions, touching •  Can conflict with verbal message •  Need to be aware of own and other’s nonverbal messages •  When verbal and nonverbal message agree, message is more

likely to be understood

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Communication Process

§  Essential elements –  Sender – individual who cerates a message to convey info/

idea to another person –  Message – info, ideas or thoughts being communicated –  Receiver – individual who receives the message from the

sender –  Feedback – method used to determine if communication

was successful •  Receiver responds back to the sender regarding the message •  Allows original sender to determine if the message was interpreted

correctly

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Communication Process In order for communication to be effective, the: §  Message must be clear

–  Message in terms understood by sender and receiver –  Health care workers must be able to effectively communicate

diagnoses, symptoms, and treatment §  Message must be delivered in a clear manner

–  Sender must use proper grammar and pronunciation –  Sender must use proper tone, pitch, voice level and speed

§  Receiver must be able to hear and receive the message –  Sender must make sure the receiver is coherent, and

understand the language being used –  Repeating the message, changing the terms used or

language used may help to clarify the message

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Communication Process In order for communication to be effective, the: §  Receiver must be able to understand message

–  Usage of medical terminology may cause miscommunication –  Health care workers should ask questions or repeat info

differently if it appears the patient doesn’t understand –  Receivers must be confident in the sender before they

accept and understand the message §  Environment should be clear of interruptions and

distractions –  Limit distractions such as phone calls, television, iPads

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Listening §  Listening is essential to effective communication §  Attempt to hear what other is really saying §  Need constant practice §  Good listening techniques include:

–  Showing interest and concern for what speaker is saying –  Be alert and maintain eye contact (if appropriate) –  Avoid interrupting speaker –  Avoid thinking about how you are going to respond –  Try to see the speaker’s point of view & keep your temper

under control –  Reflect statements back to speaker –  Ask for clarification if you don’t understand part of message

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Barriers to Communication §  Barrier - something that gets in the way of clear communications §  3 Common barriers (Physical, Psychological, Cultural) §  Physical disabilities

–  Deafness or hearing loss •  Try using body language, face the patient when speaking,

write message –  Blindness or impaired vision

•  Use a soft tone of voice, describe events, explain sounds, announce when you come into room

–  Speech impairment •  Encourage patient to take their time during communicating,

ask questions that don’t require long answers, repeat message back to patient, provide a picture board or other means of communication

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Barriers to Communication Common barriers §  Psychological barrier

– Caused by prejudice, attitudes, and personality – Judgments typically based on appearances,

stereotypes, social and economic status – Health care workers must put all prejudices aside

and show respect to all patients •  Must be respectful even if the patient has a negative

attitude

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Barriers to Communication Common barriers §  Cultural diversity

– Main barriers include: •  Beliefs and practices regarding health and illness •  Language differences •  Eye contact •  Ways of dealing with terminal illnesses •  Touch

– Respect and acceptance of cultural diversity is essential for health care workers

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Recording and Reporting

§  Observe and record observations §  Use all senses in the process

– Sight – skin color, swelling, rash, urine color – Smell – unusual body odor, breath, smell of

wound, urine or stool – Touch – feel for pulse, dryness or temp of

skin, swelling – Hearing – listen to heart beat, breathing,

coughs, speech

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Recording and Reporting

§  Observations must be reported promptly and accurately – Subjective observations – complaints made

by patient, report in exact words patient uses •  Cannot be seen or felt by health care worker

– Objective observations – seen and measured •  Blood pressure, temp, swelling, cut, rash

§  Criteria for recording observations on a patient’s health care record

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Recording and Reporting

§  Observations are recorded on a patient’s health care record –  Need to be written accurately, concise & complete

•  Sign and date all entries •  Errors should be crossed out in a neat, straight line and initialed

–  Writing should be neat and legible with correct spelling and grammar

–  Record objective observations •  If subjective observations are put in record, must be written in

exact terms patient used

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Summary

§  Good communication skills allow development of good interpersonal relationships

§  Health care worker also relates more effectively with coworkers and other individuals

Communication Skills – Count the “F”s in the following statement:

§ Fascinating fairytales are the result of years of scientific study combined with the experience of creative minds.

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Communication Skills – Count the “F”s in the following statement:

§ Fascinating fairytales are the result of years of scientific study combined with the experience of creative minds.

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Drawing a Bug

§  I am going to describe a drawing of a bug. Without seeing the drawing, you must draw the bug as I describe it to you.

§  You may NOT ask questions! §  You may NOT talk to each other!

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Drawing a bug

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Drawing a Bug Discussion questions: §  Why don't all the bugs look like mine? §  What did you think of first when you were told to draw a bug?

What did you see in your mind? §  What could we have done differently so that your drawings

and mine would have looked more alike? Could nonverbal communications have helped?

§  What would have been the advantages of allowing questions to be asked?

§  How many of you wanted questions to be asked?

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