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Module outcomes
• By the end of this module, the learner should;
PSYCHOLOGY Apply concepts of psychology in managing clients/patients
Integrate theories of personality development with provision
of nursing care
Identify and manage patients with deviations in growth &
development.

Course Outline
 Concepts of psychology
Course outline ct’
 Observational cognitive avoidance and learning
 Definition of terms
 Motivation
 Historical Background  Types of personalities
 Scope of psychology  Stress and coping
 Theories of personality development  Crisis and crisis intervention
 Human behavior and social interactions  Mental defense mechanisms
 Learning and memory  Psychology in relation to nursing
 Stages of growth and development
 Classical conditioning
 Application of theories of personality development in growth and
 Instrumental conditioning development
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What is Psychology?

Welcome

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Definition of Terms
MENTAL PROCESSES
 PSYCHOLOGY
-The scientific study of human behavior and mental or cognitive  Refer to all the internal and covert activity of our mind
processes. such as thinking, feeling and remembering.
- The scientific study of human mind including its structure and NOTE:
functioning, usually observed in behavior. The word Psychology has its origin from two Greek
words ‘Psyche’ and ‘Logos’, ‘psyche’ means ‘soul’ and
 BEHAVIOUR ‘logos’ means ‘study’. Thus literally, Psychology means
- Any activity of an organism that is capable of being observed in ‘the study of soul’ or ‘science of soul’.
response to its environment.
- Behaviour includes all of our outward or overt actions and
reactions, such as verbal and facial expressions and movements.
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 EXPERIENCE Cont’d…
Mental phenomena occurring directly to the  ATTITUDE
individual. A tendency to respond positively or negatively to either a
person, object or situation (an organism’s response to
 CHARACTER stimuli).
An evaluation of an individual`s personality
against some set standards within the society  INTELLIGENCE
focusing on morals and ethics. The ability to learn abstracts, which include learning of
vocabularies, numbers, concepts, reasoning, making
judgment and problem solving skills.

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Historical Background Ancient Greek period:

The development of psychology can broadly be traced into four Some of the key contributors were:
periods: Socrates who was interested in studying the reincarnation
of soul (embodiment in fresh). Soul or mind was
• Ancient Greek period, considered as the representation of individuals.
• Pre-modern period, Plato, a bright student of Socrates expanded Socrates
concepts in philosophy about life and soul.
• Modern period and
• Current status

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Cont’d… Pre-modern Period:

Aristotle in his book “para psyche” (about the mind or soul) It was during 1800's that Wilhelm Wundt established first
he introduced the basic ideas in psychology today, like law of psychology laboratory in Leipzig, Germany.
association.

However, the notion of psychology was primarily related to He defined psychology as a science of consciousness or
conscious experience. He proposed the Theory called
study of soul or mind at that stage and never on the
structuralism.
behavior of the individual. That is why the attention was
diverted from the study of soul or mind.

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Modern period: Current Definition:

Behaviorists (J.B Wastson, Ivan pavlov and B.F. skinner) • The modern day psychology is defined as the science
proposed that psychology should study the visible of behavior and mental or cognitive processes.
behavior which can be objectively felt and seen. Hence
they defined psychology as the science of behavior.
They however only focused on observable behaviors and • This definition comprises these things: psychology is
ignored the role of mental processes. Also, they science, it studies behavior and it studies mental
undermined the role of unconscious mind and heredity process.
in behavior.

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Aim of Psychologists
• To find out why people act as they do to give us a THE SCOPE OF
better understanding (insight) of our own
attitudes and reactions. PSYCHOLOGY

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• Biological psychology
Scope of Psychology: studies how physical and
• The field of psychology can be understood by various subfields of chemical changes in our
psychology making an attempt in meeting the goals of psychology. bodies influence behaviors
1. Physiological Psychology: for example, how the brain,
• In the most fundamental sense, human beings are biological nervous system and
organisms. hormones effect on
• Physiological functions and the structure of our body work behavior.
together to influence our behaviour.
• Biopsychology is the branch that specializes in the area. Bio-
psychologists may examine the ways in which specific sites in the
brain which are related to disorders such as Parkinson’s disease or
they may try to determine how our sensations are related to our
behaviour.

Scope of psychology ctd’ 3. Personality Psychology:

2. Developmental Psychology: • This branch helps to explain both consistency and change in a
person’s behaviour over time, from birth till the end of life
• Here the studies are with respect to how people grow and
through the influence of parents, siblings, playmates, school,
change throughout their life from prenatal stages, through
society and culture.
childhood, adulthood and old age.
• It also studies the individual traits that differentiate the
• Developmental psychologists work in a variety of settings like
behaviour of one person from that of another person.
colleges, schools, healthcare centres, business centres,
government and non-profit organizations, etc. They are also
very much involved in studies of the disturbed children and
advising parents about helping such children.

4. Health Psychology: 5. Clinical Psychology:

• This explores the relations between the psychological factors • It deals with the assessment and intervention of abnormal
and physical ailments and disease. behaviour.
• As some observe and believe that psychological disorders arise
• Health psychologists focus on health maintenance and from a person’s unresolved conflicts and unconscious motives,
promotion of behaviour related to good health such as others maintain that some of these patterns are merely learned
responses, which can be unlearned with training, still others are
exercise, health habits and discouraging unhealthy behaviours contend with the knowledge of thinking that there are biological
like smoking, drug abuse and alcoholism. basis to certain psychological disorders, especially the more
• Health psychologists work in healthcare setting and also in serious ones.
• Clinical psychologists are employed in hospitals, clinics and private
colleges and universities where they conduct research. They practice. They often work closely with other specialists in the field
analyse and attempt to improve the healthcare system and of mental health.
formulate health policies.

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6. Counselling Psychology: 7. Educational Psychology:

• This focuses primarily on educational, social and career • Educational psychologists are concerned with all the concepts
adjustment problems. of education.
• Counselling psychologists advise students on effective study • This includes the study of motivation, intelligence, personality,
habits and the kinds of job they might be best suited for, and use of rewards and punishments, size of the class,
provide help concerned with mild problems of social nature expectations, the personality traits and the effectiveness of
and strengthen healthy lifestyle, economical and emotional the teacher, the student-teacher relationship, the attitudes,
adjustments. etc.
• They also do marriage and family counselling, provide
strategies to improve family relations.

8. Social Psychology: 9. Industrial and Organizational Psychology:

• This studies the effect of society on the thoughts, feelings and • The private and public organizations apply psychology to
actions of people. management and employee training, supervision of
• Our behaviour is not only the result of just our personality and personnel, improve communication within the organization,
predisposition. Social and environmental factors affect the way counselling employees and reduce industrial disputes.
we think, say and do. Social psychologists conduct experiments Therefore, the physical aspects of employees are given
to determine the effects of various groups, group pressures importance to make workers feel healthy.
and influence on behaviour.

10. Experimental Psychology: 11. Environmental Psychology:

• It is the branch that studies the processes of sensing,
• It focuses on the relationships between people and
perceiving, learning, thinking, etc. by using scientific
methods. their physical and social surroundings. For example, the
• The outcome of the experimental psychology is cognitive density of population and its relationship with crime,
psychology which focuses on studying higher mental the noise pollution and its harmful effects and the
processes including thinking, knowing, reasoning, judging and influence of overcrowding upon lifestyle, etc.
decision-making.

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13. Sports and Exercise Psychology:

12. Psychology of Women: • It studies the role of motivation in sport, social aspects
• This concentrates on psychological factors of women’s of sport and physiological issues like importance of
behaviour and development. training on muscle development, the coordination
• It focuses on a broad range of issues such as discrimination between eye and hand, the muscular coordination in
against women, the possibility of structural differences in the track and field, swimming and gymnastics.
brain of men and women, the effect of hormones on
behaviour, and the cause of violence against women, fear of
success, outsmarting nature of women with respect to men
in various accomplishments.

14. Cognitive Psychology: Note:

• It has its roots in the cognitive outlook of the Gestalt
principles. It studies thinking, memory, language, • Psychiatry- branch of medicine that deals with
development, perception, imagery and other mental emotional and behavioral disorders.
processes in order to peep into the higher human mental
functions like insight, creativity and problem-solving. • A psychiatrist can prescribe medicine and is
• The names of psychologists like Edward Tolman and Jean considered a medical doctor (M.D.), NOT a
Piaget are associated with the propagation of the ideas of this psychologist.
school of thought.

PERSONALITY
• Definition: -
The unique characteristics each person develops in the course
of his life.
The sum total of a person, his/her psychological and
physiological characteristics that make him/her a unique
individual. E.g. behavior, conduct, temperament (mental
attitude), intellect.

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Why study personality? Personality Trait

• It helps the health workers such as nurses and clinicians to • A tendency to behave in a consistent manner in various
understand themselves, each other and their patients. situations.
• It determines success and failure in the medical field, ability to • Knowledge that a person possesses a particular trait makes
make friends and to adapt to different working conditions. prediction of her behavior possible e.g. patience, honesty,
• It influences the way one copes with pain, illness and crises. perseverance, bad temper, etc.
• It helps the health worker to understand why patients react
differently to a similar situation

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Factors Influencing
Cont’d…
Personality
Heredity Environment
• Studies have proved that individuals inherit certain • Many environmental factors determine the personality of an
characteristics of personality from their parents, e.g. general individual.
appearance, reaction tendencies (alertness, dull etc.) Social-cultural factors
• In most societies the male is supposed to be aggressive,
strong, not cry aimlessly and endure a lot of pain and on the
other hand girls are expected to be submissive and polite.

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Cont’d… TYPES OF PERSONALITY

Learning • There are quite a number of types of personality:
• Plays a major role in moulding and influencing one`s – Plato: body elements such as gold(rulers),iron(workers)etc
personality throughout life, beginning from infancy. – Sheldon: body physique i.e. endomorphic, ectomorphic etc
Self perception – Hans: relativity to external world i.e
introversion/extroversion (broad categories)
• The environment helps the child develop self perception, and
the persons he interacts with reinforce that perception e.g. – Hippocrates: body chemistry i.e. sanguines, melancholics etc
failure in life or successful in life.

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Introverts Extroverts
• Are reserved, withdrawn persons who are pre-occupied • Are outgoing, active persons who direct their energies and
with their inner feelings and thoughts. interests towards other people and things.
• They tend to be imaginative, slow in thinking, pessimistic, • They tend to be sociable, talkative, present oriented, tough
shy, unfriendly, reserved, conservative, likes solitude, minded, unsympathetic, aggressive, friendly, adaptive, makes
cautious, passive, tender hearted and sympathetic and and sticks to their own laws, optimistic, little fantasy and likes
often retreats after meeting difficulties. other people’s company.

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Sanguines (“let’s have fun”) Melancholy (“let’s get

organized”)
Great front-door person/salesperson
• Enthusiastic and expressive, makes friends easily, • Analytical, genius prone, plans and organizes, neat and
• Creative and fun, volunteers for jobs, talkative, storyteller orderly.
• Don’t have much follow-through, talk too much, exaggerates, • Can be counted on to finish a job, detail-oriented,
• Many fans but few friends, self-centered, disorganized, economical, compassionate, perfectionists, creative.
manipulates through charm • Easily depressed, assumes worst in people and
situations, low-self image, procrastinate through
planning, has unrealistic expectations.
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Choleric (“let’s get Phlegmatic (“let’s relax”)

moving”)
• Born leader, driven, goal-oriented, strong-willed, can run • Easy-going, low-key, inoffensive, patient, calm, cool,
anything, thrives on opposition. collected, realistic
• Independent, makes split-second decisions, solves • Mediator, good listener, dependable, cheerful.
problems, is usually right, active. • Not enthusiastic, dislikes change, procrastinates, can
• Doesn’t see faults, compulsive worker, needs control, seem lazy, indecisive, emotionally closed.
• Can come off bossy/domineering, not so good people • Avoids conflict, has a hard time with discipline,
skills, unemotional and cold. pessimistic
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Others…
Obsessive: perfection, rigid and does not like change.
Schizoid: a loner, withdrawn, emotionally cold.
Cyclothymic: outgoing, very talkative, excited about life. Very
warm emotionally
Hysterical: seek a lot of attention, very selfish, dramatic.
Paranoid: suspicious of everyone, difficult to work with, rigid and
un-adaptable

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HUMANISTIC THEORY
THEORIES OF PERSONALITY MASLOW’S HIEARARCHY OF NEEDS
DEVELOPMENT

Abraham Maslow

Introduction  Abraham Maslow arranged human needs into a

• Maslow's hierarchy of needs is hierarchy starting from the most basic to less basic
a theory in psychology proposed
by Abraham Maslow in 1943. needs
• Maslow's hierarchy of needs is often  He emphasized on two things:
portrayed in the shape of a pyramid
with the largest, most fundamental ◘Capacity of human growth/self actualization
needs at the bottom and the need
for self-actualization and ◘Individual’s desire to satisfy variety of needs
transcendence at the top. In other  He developed a hierarchy of needs known as
words, the crux of the theory is that
individuals’ most basic needs must Maslow’s hierarchy of needs.
be met before they become
motivated to achieve higher level
needs
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Maslow’s hierarchy of needs.

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Cont… Safety and Security needs

 When physiological needs are satisfied, concern for safety
Physiological Needs and security from harm, both physical and psychological
 Physiological needs are considered the main physical emerges. The normal adult is able to protect himself, is safe
requirements for human survival. This means that and usually does not feel endangered.
Physiological needs are universal human needs.  These include job security, health, and safe environments.
 These are basic needs for survival – Air, food, water,  Safety and Security needs include:
elimination, sleep, rest, clothing, shelter, avoidance of Personal security
pain, sex etc. Emotional security
Financial security
Health and well-being
Safety needs against accidents/illness and their adverse impacts
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Cont… Social Belonging and Affection

 Note: The patient may be afraid in response to the many  Every person desires companionship and acceptance from
different people who enter his room. Diagnostic tests and others. Man as a social animal hates isolation. He needs a
therapeutic procedures may increase his fear. The nurse family and friends who care.
should promote the safety of the patient.  According to Maslow, humans need to feel a sense of
belonging and acceptance among social groups, regardless
of whether these groups are large or small
 Social Belonging needs include:
Friendships
Intimacy
Family
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Self Esteem / Respect /Image / Concept Self Actualization

 Esteem needs are ego needs or status needs. People develop  Is self fulfillment or attainment of one`s potential. This is a
a concern with getting recognition, status, importance, and rarely reached level of needs. Many others are either
respect from others. materially or psychologically deprived and are only able to
 This is conveyed by the recognition, time, attention and meet the lower level of needs. It calls for creativity, hard
thoughtfulness we give to each other as a unique personality, work and determination to venture ahead.
worthy and dignified. If this need is unmet, one becomes  "What a man can be, he must be. "This quotation forms
dependent on others, loses confidence and is incompetent. the basis of the perceived need for self-actualization.
 Maslow describes this level as the desire to accomplish
 Psychological imbalances such as depression can distract the
everything that one can, to become the most that one can
person from obtaining a higher level of self-esteem. be.

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Ct,… Transcendence
 Self-actualization can include:  In his later years, Abraham Maslow explored a further
 Mate Acquisition dimension of motivation, while criticizing his original vision
 Parenting of self-actualization.
 Utilizing Abilities  By this later theory, one finds the fullest realization in
‘giving oneself to something beyond oneself.’
 Utilizing Talents
 Transcendence refers to the very highest and most inclusive
 Pursuing a goal
or holistic levels of human consciousness, behaving and
 Seeking Happiness
relating.

Maslow’s dimensions of motives Conflicts of motives

Physical Dimension of motives
i. The basic physiological needs Motivational conflicts always concern an
ii. The safety and security needs individual’s conflict within himself:
 Social Dimension of motives Approach-Approach
i. Belonging and social activity
ii. Esteem and status in the society Approach-Avoidance
Avoidance-Avoidance
 Psychic Dimension of motives
i. Self actualization and fulfillment(self development).
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5 Stages of Development
Psychosexual Theory • Freud argued that human beings
develop through series of five
psychosexual stages.
• These stages try to express the
sexual energy (libido) and
aggressiveness in various forms in
By Sigmund Freud each stage. He further argued that
deprivation or overindulgence of
these energy leads to a scenario he
67 referred to as fixation.

1. Oral Stage (0 – 18months) 2. Anal Stage(1½-3yrs )

 In this stage, pleasure is achieved through
stimulation of the mouth e.g. thumb sucking,  Pleasure is achieved from holding and expelling faeces
suckling etc. i.e. bladder and bowel movements. Conflict occurs
regarding toilet training.
 Primary conflict: weaning. If fixation occurs, the
 Praise and reward for using the toilet at the
individual would have dependency or aggression.
appropriate time encourage positive outcomes and
Oral fixation can result in problems in eating,
help children feel capable and productive.
drinking, smoking , pen/nail biting, gum chewing,
abusive. 70

Cont’d… 3. Phallic Stage (3 – 6yrs)

 If punishment, ridicule or shame for accidents is used  Primary focus is on genitals, hence, is characterized by sex
then it can result in the anal expulsive personality and gender identification.
(lack of self control, generally messy, stubborn,  Oedipus complex for boys and Electra complex for girls. Fear
wasteful or destructive) of castration-known as castration anxiety; Girls develop
penis envy.
 If parents are too strict or begin toilet training too  Fixation: sexual deviances (overindulging or avoidance,
early, anal-retentive personality develops in which weak or confused sexual identity.
individual is stringent, orderly, rigid, obsessive and
perfectionist.
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4. Latent Stage (6 – 12yrs) Cont’d…

 In this stage, sexual impulses are repressed.  The child becomes creative and industrious and will
explore his talents and be ready to tackle his
 Individuals in this stage develop social friendship and problems for solutions.
socialism characterized by group formation and fierce
group loyalties.  If unsuccessful, because the parents were not
 Boys cling together and shun girls and girls despise supportive and challenging, the child becomes scared
boys. The child identify peers, and is occupied by and timid and will hate competition, he will not try
school work and play. anything because he knows he is a failure.
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Cont’d…
5. Genital Stage(12-18yrs) • They tend to resent commands, disagree with parents,
want independence and behave like mature adults.
• This is the adolescent stage. Gratification is obtained
from actual genital stimulation hence there is • Lack of support and understanding leads to rebellion,
development of intimate /romantic friendship with run away (truancy) from the family, join gangs where
the opposite gender. they start abusing drugs, present antisocial behavior
and will never be what or who they are expected to be
• Identifies with an adult they want to emulate from the i.e. role diffusion.
previous stages and start behaving like those adults.
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Structure of Personality
 According to Sigmund Freud, personality is composed of
3 (three) major systems:

• The Id
• The Ego and
• The Superego

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The Id The Ego

• Forms the original system of personality and is present • It delays the satisfaction of a need until an appropriate
at birth. It is basically unconscious and has no time, place, or object is available. It mediates between
knowledge of the outside world. the id and the super ego.
• The id is the most primitive and is driven by impulses.
“I want it” • Also called the rational self or the “reality principle,”
• It demands immediate gratification of the needs
because it is not governed by law of reason and logic.
• Also known as the “pleasure principle”.
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Cont’d… The Superego

• It develops as from the age of 2 years in the anal stage • This is the last system of personality to develop.
when the child starts meeting social demands like
toilet training, discipline, holding on without • It contains values, legal, moral regulations, and
demanding immediate gratification. social expectations (moral principle)
• It originates from the child`s assimilation of his
• It involves logic, thinking, reasoning and finding parents` standards regarding what is good or bad
solutions to problems or in contact with reality. and sinful.

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Cont’d…
• It begins with the resolution of the Oedipus/Electra
Complex at age 5 – 6 years and is referred to as the
Sociological component of the personality.

• Its main function is to oppose the id

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 According to Erickson,
identity is very personal and
develops from our heritage
Psychosocial Theory and history.
 Course of development is
determined by the interaction
of the body, mind and
By Erick Erickson cultural influences.
 The world gets bigger as we
go along and failure is
cumulative.
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8 Stages of Development Basic Trust Versus Mistrust

1.Trust versus mistrust • Occurs in infancy (birth-18 months).

2.Autonomy versus shame/doubt • Babies must learn to trust their parents care and
3.Initiative versus guilt affection.
4.Industry versus inferiority • If not done the babies could develop a distrust and
5.Identity versus role confusion view the world as inconsistent and unpredictable.
6.Intimacy versus isolation • The favourable outcomes are hope, trust and
7.Generativity versus stagnation optimism.
8.Ego integrity versus despair
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Autonomy versus shame/doubt Initiative versus guilt

• 3 to 5years (late childhood)
• In early childhood (18 months-3 yrs).
• Child becomes assertive and takes initiative
• Child learns to feed themselves and do things on
• Being too forceful may lead to guilt
there own.
• The child is testing the ability to compete in the outside
• Or they could start feeling ashamed and doubt their world. They desire to copy the adults around them and take
abilities. initiative in creating play situations
• Important Event: Toilet Training • The desirable outcome is sense of purpose and initiative
• The child learns to perform physical skills, and
develops self-control & courage.
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Industry versus
Identity versus role confusion
inferiority
• Adolescence (13-18 years of age).
• 5 to 12 years (School age) • Acquire a sense of identity or can become confused about ones
• Learn to follow the rules imposed by schools or home or the role in life.
child can start believing they are inferior to others. • Questions who you are and if your happy.
• Desired outcome: competence, development of intellectual, • Source of interaction: Peer and groups
social and physical skills. • Desirable outcome: identity in occupation, gender roles,
• The child must learn new skills or risk inferiority, failure, and politics and religion.
incompetence.

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Intimacy versus Generativity vs. Stagnation

isolation
• Adulthood (40-65 years of age).
• Young adulthood (18-40 years of age).
• Making use of time and having a concern with helping
• Develop a relationship and joint identity with a partner or can
become isolated and stay away from meaningful
others and guiding the next generation or can become
relationships. self-centered, and stagnant.
• Questions if the person is ready for new relationships, or if • Questions what the person will do with their extra
there is a fear of rejection. time.
• Desired outcome includes: forming close relationship and • Desired outcome :care and concern for family and
career development society.
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Integrity vs. Despair

• Late adulthood/old age (60 and above).
• Understand and accept the meaning of the life spent or
complains about regrets, not having enough time, and not
finding a meaning throughout life.
 Relatively permanent change in knowledge
• Questions ones overview of their entire life.
or behavior resulting from experience.
• Source of interaction: mankind
• Expected outcome is satisfaction with life spent.

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Definitions:
An Instinct
Learning  An inborn complex behaviour found in members of a species
 Relatively permanent change in knowledge or behavior such as nest building in birds.
resulting from repeated experiences. Maturation
 Is the sequential unfolding of inherited predispositions(such as
Reflex walking in human infants).
 Is an inborn, involuntary response to a specific kind of
stimulus, as in limb-withdrawal reflex (withdrawing your
hand after touching a hot plate)

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Types of Learning Learning Theories

 Psychomotor Learning: acquisition of physical skills,
coordination of muscles and body parts. Classical Conditioning by Ivan Pavlov
 Cognitive Learning: ability to think, form ideas and concepts, Operant Conditioning by B.F. Skinner
synthesis, analyze and evaluate issues logically and creatively. Cognitive Learning by Jean Piaget
 Affective Learning: involves emotions, values, feelings and Social Learning by Albert Bandura
attitudes of an individual.

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Classical Conditioning
 By Ivan Pavlov,(1849-1936). Was a Russian Physiologist who
experimented on dogs.
 Pavlov demonstrated that dogs could be conditioned to
salivate in response to new stimulus, such as ringing bell or
light, if this had been paired or presented together with food
several times.
 The food is the unconditioned stimulus (US) & the bell is
the conditioned stimulus (CS). Salivation is the
conditioned response (CR).
 Bell + food led to salivation; Salivation on eating and smell of
food; Later, salivation after ringing the bell without food, after
several episodes where the bell preceded the food. 101

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Operant conditioning Cognitive learning

• B.F. Skinner studied the relationship between behaviour and their  According to Jean Piaget, learning can occur without reinforcement
consequences. of overt actions, a process he called latent learning.
• Animals and people learn to operate on the environment to produce  The proponents of this theory argue that human being is not a
desired consequences. passive organism, but is capable of processing information and
• Learning in this case is under the control of the individual, who comprehending the relationship between cause and effect. The
operates or influences the environment, hence the term operant processed information is stored and may be retrieved later when
conditioning required.
• There is a reward or a punishment for behaviour, hence learning  One actively constructs knowledge through negotiation and social
occurs. interaction with the immediate environment.

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Social Learning Theory

 Albert Bandura.
 Considers how individuals learn through observing the
behavior of others. i.e. most human behavior is learnt
observationally through modeling.
 This theory proposes that people learn by imitating the The process by which information acquired is
behavior of other people. Other terms used are role modelling encoded, stored and retrieved when needed.
and identification.

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Memory ct’
 Memory refers to those processes involved in the acquisition
of information, its subsequent retrieval and use.  Memory plays an important part in learning. Learning implies
retaining of facts. If nothing is stored from previous
 Memory process can be divided into three main components:
experience, then no learning can take place
 Registration
 Thinking and reasoning are also done with remembered facts
 Retention
 Recall and recognition

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Types of memory Information Processing

 The following are types of memory: • Encoding allows information from the outside world to be
 Immediate or short-term memory: for events that have occurred sensed in the form of chemical and physical stimuli.
within the past 30 seconds • Storage involves information maintenance over short periods
 Recent memory: for events over the past few hours or days of time.
 Recent past memory: this refers to information retained over the • Retrieval: Stored information must be located and returned
pest few months. to the consciousness.
 Remote memory: refers to the ability to remember events that
have occurred in the distant past. - Memory enables people to recall the who, what, when, where,
how and why in everyday life.

110

Factors Influencing Memory Loss Cont’d…

 Attention
Interference can hamper memorization and retrieval:  Organization of content
Retroactive interference: when learning new information makes it harder  Age
to recall old information and
 Health and emotional status
Proactive interference: where prior learning disrupts recall of new
information.  Association developed
However, there are situations when old information can facilitate learning of  Intelligence
new information (positive transfer)  Value of content
 Study and rehearsal skills
 Environment
 Level of information processing
 Methods of learning/teaching
111 112

Improving the Memory STRUCTURE AND

FUNCTIONS OF THE MIND
Healthy eating(balanced diet)
 Part of the brain that is responsible for thoughts
Physical fitness(exercises)
and feelings.
Stress reduction measures
Memory exercises improves cognitive function and brain  According to Freud, the mind is divided into three levels

efficiency e.g. brain teasers and verbal memory training of existence or consciousness:

techniques
Adequate sleep.
113 114

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The Conscious Level Subconscious Level

 This is a small part which forms 1/6th of the total size of the
mind, regarded as the sense organ of attention.  Forms 1/6th of the total size of the mind.
 It functions only when the individual is awake. This first  It is accessible to both the conscious and the unconscious
level is responsible for – rational thinking, good judgment, levels of the mind.
correct perception of the environment, emotions and  Acts as a censor (filter) of all information stored in the
establishment of personal relationships. unconscious level reaching the conscious, to store all
information and experiences from the conscious mind for
memory, and to select which experiences should be
repressed into the unconscious mind (never to be
remembered).
115 116

Unconscious Level
 Comprises 2/3rd of the entire mind.
 It contains all repressed ideas, psychological experiences,
information and emotions.
 Information stored at this level of the mind cannot reach the
conscious level unless through psychoanalysis.
 The information from this level can reach the conscious level
through – a dream but in a distorted way, slip of the tongue,
unexplained behavioral responses, jokes or lapses of memory.

117

DEFINITION Theories of motivation

 MOTIVE: Something that has the power to initiate action. 1. Homeostasis & the Drive Theory
Refers to the underlying factors that energize and direct  It is essential that the body maintains a constant internal
behavior. environment for its optimum functioning.
 EMOTION: is the feeling, tone or response to sensory input  Corrective measures are in place to ensure that the body’s
from the external environment or mental images. temperature, body fluids, and hormones are maintained within
a certain range.
 MOODS: Are states of emotional reaction that ls for only a
 For instance, when blood glucose levels fall below a certain
limited period limit, the organism feels hungry and will seek food in order to
 Temperament: An individual’s habitual way of expressing rectify the anomaly. Likewise, when body fluids are depleted,
emotions the organism will seek water as the kidneys also try to conserve
water.

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2. Psychoanalytic theories 3. Behavioural theory

 Sigmund Freud stated that human behavior is determined by
two basic forces: the life instincts (eros) & the death instincts  This theory holds that an organism is likely to engage in a
(Thanatos). The former explains the behavior that is directed certain type of behavior if it were rewarded following
towards the preservation of life while the latter leads to food-seeking behaviour.
destruction for example aggressiveness.

4. Drive reduction theory 5. Humanistic theory

 This theory suggests that tension builds up in an  By Abraham Maslow.
organism in response to certain needs. As the goals are  Maslow reasoned that human motivations are organized in a
achieved, for example obtaining food, tension is hierarchy of needs.
reduced and this is accompanied by a pleasurable  He stated that the lower needs in the hierarchy must be partly
feeling. fulfilled before those at the next level can assume importance.
If they are not, then the organism remains preoccupied with
them until the needs are met.

Take away…. STRESS

Definition
Discuss the application of the Humanistic • Stress is a state of severe physiological and psychological response
to harmful or potentially harmful circumstances.
Theory in our daily lives. • It is a state of severe physiological and psychological tension or It
Discuss the application of the motivation can be also defined as a non-specific response of the body to any
demand.
theories in our daily lives.
• A stressor is a stimulus which causes stress e.g. bereavement,
divorce or a critical event such as robbery or the demand of life
• One’s responses to stress are influenced by: personality (our
strength), the burden/type of stressor, subjective interpretation of
the stressors.

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Causes of stress Responses to Stress

- Stressors can be sudden, overwhelming or cumulative. Examples • Stressors and to some extent stress are normal and at times are
include: necessary for one to achieve certain goals in life. It becomes
 Life crises e.g. accidents, death of spouse or divorce. abnormal if they produce signs and symptoms that become the
 Transitions e.g. divorce, bereavement and retirement. problem.
 Catastrophes-natural and otherwise e.g. earthquakes and floods.
• Individuals can be helped to cope with or minimize life stressors and
 Daily hassles, little things in life that go wrong.
still lead a relatively normal lives with health education and support
 Frustration and conflicts. systems.
 Uncertainty, doubt and inability to predict the future
• Physical stress: Pain, hunger, illness, fatigue, unmet basic needs.
• Psychological stress: Anything causing anxiety, tension or fear.
• Environmental stress: Weather, other human beings, pollution, natural
and artificial disasters. 127 128

• Psychological responses:
• Physiological responses: – The individual may display self-destructive lifestyles & risk-
taking behaviors such as drug abuse, suicidal gestures and
– The body prepares itself either to fight or for flight. self neglect.
– All the body’s reactions to stress affect health. – Aggressiveness due to frustration
– Prolonged stress may cause high BP, ulcers, heart – Anxiety. It may manifest with physical symptoms of
diseases, autoimmune disorders such as rheumatoid autonomic hyperarousal and activity.
arthritis & allergies – Depression
– Inhibited sexual drive
– Spiritual signs and symptoms of excessive stress may
include doubts about one’s faith, loss of self confidence or
loss of purpose.
129 130

Stress in Patients is
Signs and symptoms of stress
caused by:
Admission to hospital On the body
Operations • Headache
Anesthetics • Muscle tension or pain
Sharing a ward with strangers • Chest pain
• Fatigue
Use of bedpans
• Change in sex drive
Injections and • Stomach upset
Being done tests/investigations. • Sleep problems

131 132

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On the mood
On behaviour
• Anxiety i.e. tension
• Restlessness • Overeating or under eating
• Lack of motivation , focus, or concentration • Anger outbursts
• Irritability or anger • Drug or alcohol abuse
• Sadness or depression • Tobacco use
• Frustration • Social withdrawal

133 134

Stress Coping Mechanisms: ANXIETY

 Confronting the stressor
 Avoiding situations that may cause stress
Anxiety
 Change your stressors e.g. take a break, switch job • A vague sense of fear, dread, uneasiness
 Maintain a reasonable work and personal schedule Phobia
 Engage in a Physical activity
• A pathologically strong fear attached to objects or situations
 Meditation, relaxation techniques e.g. slow music which in themselves are harmless.
 Discussing situations with a spouse / close friend/priest or
Praying/going to church
• Anxiety may progress to panic and interfere with mental and
social functioning(Neurotic breakdown).
 Taking a bath or shower
 Laughing or crying
 Seeking counseling. 135 136

Degrees of Anxiety
Mild anxiety
• Motivates the person to be more physically and mentally CONFLICT AND
alert.
Panic states
ADJUSTMENT
• Very high levels of anxiety that incapacitate an individual.

Welcome
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Frustration:
Types of conflict
• Is the blocking of a motive by some kind of obstacle. An Approach-approach conflict
obstacle could be like a traffic jam, personal shortcoming, There are two goals, and to attain one means that the other
conflicting motives or conflicts. goal must be given up. E.g. a final year student medical student
• The frustrated individual becomes intolerant and physically cannot afford to be in night parties and still expectant to excess
aggressive, more prone to misunderstanding while others are academically. So, he gives up partying although he misses them
more likely to speak hurtful words. a lot.
Conflict
• Is the simultaneous arousal of more incompatible motives,
resulting in unpleasant emotions, such as anxiety or anger. It’s
a pair of goals that cannot be attained.

Avoidance-avoidance conflict Approach-avoidance conflict

Both alternatives are unpleasant and yet one has to choose This occurs when fulfilling a motive which will have both
either. E.g. a patient has an abdominal tumour, which causes pleasant and unpleasant consequences. E.g. a young male
unbearable pain and discomfort. Alternatively, surgery, which doctor is torn between getting married or not. Being married is
has very little success rate is the only available remedy, yet the attractive and socially fulfilling, but it also means added
patient needs to be relieved of the pain. It becomes naturally responsibilities and restrictions.
difficult for the patient to choose either of these two.

Coping strategies 2. EMOTION FOCUSED:

1. PROBLEM FOCUSED:
• These are used when the problem is uncontrollable. They are
• Define the problem two types:
• Come up with alternatives A) Behavioural strategies
• Weigh the alternatives-cost and benefits Exercising
• Choose among the alternatives Using alcohol or other drugs
• Implement the chosen alternatives Venting anger
Seeking emotional support from friends

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b) Cognitive strategies: CRISIS AND CRISIS MANAGEMENT

Temporarily setting aside thoughts about the problem Definition
Changing the meaning of the situation
• A sudden event in one’s life that disturbs homeostasis, during
Reappraising the situation which usual coping mechanisms cannot resolve the problem.
Other coping strategies:
Isolating oneself
Thinking about how badly one feels
Worrying
Repetitively thinking about how bad things are
Engaging in a pleasant activity like going to parties
146

Balancing stressors
Characteristics of a Crisis
• Occurs in all individuals at some point and is not necessarily
equated with psychopathology
• It is precipitated by specific identifiable events.
• Crises are personal by nature.
• Crises are acute, not chronic, and will be resolved in one way
or another within a brief period.
• A crisis situation contains the potential for psychological
growth or deterioration.

147 148

Types of Crises Crisis Intervention

• Maturational/Developmental crisis
Aims
• Situational/dispositional crisis
• Social or adventitious(accidental) crisis
• To restore person to pre- crisis level of functioning and
order; method resembles the phases of nursing
• Crises of anticipated life transitions
process
• Crises reflecting psychopathology
• Psychiatric emergencies

149 150

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Phases of crisis intervention • Analysis and planning

- organize assessment data
• Assessment
- analyze the data, i.e. identify facts, formulate
-identify precipitating event alternatives
-assess patient's perception of event - explore options to resolve the problem i.e.
-assess available coping skills and resources advantages and disadvantages of each option
-assess patient's level of anxiety as well as suicidal - decide on the best steps to achieve the solution
or homicidal potential

151 152

Implementation • Evaluation
• change the patient's physical situation by; - determine effectiveness of implementations by
Providing emotional support and shelter. observing behavioral outcomes and comparing them
Clarify any misconceptions. with goals.
Secure economic and social resources by referring patient to - refer patient for additional help if outcomes differ
appropriate support groups. from the planned ones.
Help patient develop and test possible solutions
Acknowledge multiple feelings the patient has about the
crisis to help patient sort out and express fears and
expectations
153 154

MENTAL DEFENSE MECHANISMS

Description
• Defence mechanisms are the unconscious strategies that
MENTAL DEFENSE people use to deal with negative emotions. They limit
awareness so that life-threatening and anxiety cues can be
MECHANISMS excluded

• It does not solve the problem or alter the anxiety but changes
the way the person thinks about whatever is disturbing him.

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Common Defence mechanisms Isolation

• In this defence mechanism, dangerous memories are
Denial (Self Deception)
allowed back into the consciousness, but the
associated motives & emotions aren’t recalled.
• Involuntary and automatic distortion of an obvious • Separation of memory from emotion...can remember
aspect of external reality. e.g. An ill person refusing to and talk about the trauma but feels no emotion -- the
accept a diagnosis even though a clear explanation was Person talks about the incident as if it is someone
given of which the patient understood. else's story.
• Accomplished by talking ‘third perceptual thinking.’

157 158

Displacement Conversion
• This is the transfer/Shifting of affect or feeling, usually • Mental conflict converted to a physical symptom...
anger or fear, from the source to another source less e.g., a soldier on being deployed into battle is
threatening commonly known as "dumping on" conflicted about his desire to serve his country but
someone e.g. a man reprimanded by the boss may go believes it is wrong to kill for any reason develops
home and beat the wife, the beaten wife may beat the paralysis, blindness, or deafness with no medical
children. cause.

159 160

Projection Introjection
• During projection, an individual unconsciously • In this defence mechanism, the victim takes in and
disowns an attitude or attribute of his own and ‘swallows’ the values of others.
ascribes it to someone else. • The opposite of projection - subconsciously "takes in"
• Occurs when one`s own undesirable attitudes are to self an imprint (or recording) of another person
attributed to another person or object e.g. A person including all their attitudes, messages, prejudices,
who slips over an object on the floor and falls, and expressions, even the sound of their voice, etc.
blames the object rather than his own behavior for the
accident; ‘I hate you’ becomes ‘you hate me’.

161 162

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Reaction Formation Rationalization

• When an individual gives a reason for his behavior The explanation of behavior in acceptable terms that
which is opposite of its true cause e.g. parents of un- avoid giving the true reasons or avoid ctiticism i.e.
wanted child who spoil the child to reassure behavior justification. For instance a patient might say
themselves that they are good parents. he was going to look for his friends to justify his
wandering away from home.

163 164

 Sublimation Suppression
• It involves substituting unacceptable suppressed type • Painful, frightening, or threatening emotions,
of behavior for another more acceptable form e.g. a memories, impulses or drives that are consciously
potential murderer becomes a butcher; unfulfilled pushed or "stuffed" inside.
need to give maternal care may be gratified in the care • It takes a lot of energy to keep material
of the sick. "stuffed"...energy that could be used for more
productive living.

165 166

Repression
 Regression
• Painful, frightening, or threatening emotions,
memories, impulses or drives that are subconsciously
• Is turning back to an earlier method of behaving
pushed or "stuffed" deep inside.
where there was no threat.
• Giving up current level of development and going
Aggression back to a prior level... and older child under stress
• An attitude of hostility usually resulting from begins wetting the bed or sucking a thumb after a
frustration or a feeling of inferiority long period without that behavior.

167 168

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 Fantasy
 Identification
• Using imagination to create a picture that exists only
• People who feel inferior may identify themselves
in the mind e.g. day dreaming; an ill person may
imagine himself well and without the need for health
with successful causes, organizations or persons
care. in the hope that they will be perceived as
worthwhile.
• Fantasy thinking, unlike reasoning, occurs without
conscious control. One is largely cut off from the
• Its utilized as a defense mechanism against
outside world and from reality, and indulges in anxiety of inferiority.
“wishful thinking”.
169 170

 Compensation
• This is where one tries to put up a behavior that
makes one more satisfied in areas where one is
inadequate e.g. a short man makes most noise; a very
PSYCHOLOGY RELATED TO
ugly girl excels academically; short women wear high- NURSING
heeled shoes to be taller.

171

PATIENT`S REACTION TO Cont’d…

HOSPITALIZATION
• AIMS OF THE NURSE
• Every patient reacts differently to illness and hospitalization due
to-; Understanding the patient
Age Accepting the patient as he is
Experience in life Assessing the patient to identify the coping
Nature of illness mechanisms in terms of the illness and hospitalization
Support given by significant others. Assisting the patient to use their resources to cope with
• The nurse has to assess the patient`s reaction, respond and the illness and hospitalization
support him as an individual.
Establishing Nurse – Patient Relationship
173 174

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NURSE – PATIENT RELATIONSHIP Objectives:

• To establish rapport so as to make the patient feel accepted
and have free communication of his problems.
• Is a relationship established between the nurse and • To assess the patient`s condition
the patient with the aim of identifying patient`s needs • To use the identified problems / needs to formulate a plan of
/ problems and together work out a solution. care
• Together with the patient work out solutions and meet the
patient`s needs
• To help the patient attain independence and self- reliance

175 176

Phases of Nurse – Patient Relationship Working Phase

Introductory Phase • In this phase the patient is supposed to have accepted
• This is the initial contact between the nurse and the and trusted the nurse as a dependable person.
patient. • It consists of therapeutic actions that will help the
• Basically they’re strangers i.e. the patient who is in need patient towards recovery.
of help or assistance to solve his problems and the nurse
• The nurse works on the patient`s problems and
who has professional knowledge and willingness to assist.
together with the patient find solutions. It may take a
• It is centered on mutual attempts to know each other and
long or short time depending on the patient`s rate of
work with each other.
recovery and nature of illness.

177 178

Termination Phase
• The nurse attempts to gradually bring the relationship to an
end with the patient`s recovery through helping him develop
independence and self reliance towards the management of STAGES OF GROWTH &
his own health.
• It can be traumatic to the patient and the nurse if not well DEVELOPMENT
handled due to mutual information they have shared together.
Hence the nurse must maintain and practice her ethics and
encourage the pt to use their own resources to keep healthy.

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Objectives Definitions
To assist the students know:-
 Growth is an increase in physical size of the whole body
a. The normal growth and development so as to detect any or its parts (i.e. maturity of the body structure) and can be
deviations early enough and take appropriate action measured in centimeters and in kg.
b. Factors that influence normal growth and development  Development is the process of gradually acquiring
c. Developmental milestones. certain skills and feelings as the child grows up, or,
d. Application of theories of personality development in increase in complexity of the body`s structure, formation
growth and development. and function, especially of the central nervous system
(CNS).

Reasons for studying Growth &

Cont… Development
Milestone  Recognize the importance of primary care relationships
An action or event marking a significant change or stage in  Recognize the uniqueness of each child
development.  Have realistic expectations of young children
 Provide developmentally appropriate play and learning
activities
 Protect infants and toddlers from hazards
 Monitor how children are progressing in
order to detect delays

Factors That Influence Growth and

Development Cont…
 Heredity:  Environment:
The height, weight and rate of growth are more alike in a) Before Birth.
brothers and sisters than among unrelated people.  Malnutrition of the mother, especially deficiency of iron
Congenital abnormal conditions are also transmitted (anemia), calcium or vitamin D.
through the genes.  Infections – viral diseases e.g German measles (rubella),
chronic malaria , can be the cause of prematurity or small
full-term babies.
 Congenital diseases especially syphilis in the early
months of pregnancy.

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Cont… Cont…
 Damage to the fetus caused by exposure to x-rays during  During Birth:
the early months of pregnancy.  Complicated births, birth injuries especially the brain due to
unskilled midwifery, prolonged labor, instrumental deliveries,
 Mechanical injury or an abnormal position in the uterus. breech presentation.
 Lack of oxygen to the fetus due to poor development of  Following Birth:
the placenta, drugs, alcohol, smoking etc. a) Nutrition/malnutrition: “You are what you eat”.
 Physical disorders that cause mental retardation e.g. Malnutrition due to failure of breast-feeding, poverty and
Deafness, blindness. No matter how superior the ignorance
environment, a baby so affected will be retarded. c) Lack of adequate clothing or housing.
d) Unfavorable climate conditions e.g. extreme heat or cold.

Cont… Cont…
 Sex
 Behavioral Influences
 Sex acts as an important factor of growth and development.
 Intellectual stimulation (books, music etc), -Motivation to There is difference in growth and development of boys and
help in competition, - Interpersonal relationships, - girls.
Education, - Presence of a handicap.  The boys in general, taller, courageous than the girls but
Girls show rapid physical growth in adolescence and excel
boys.
 In general the body constitution and structural growth of
girls are different from boys. The functions of boys and
girls are also different in nature.

Cont… Cont…
 Nutrition  Exercise
 Growth and Development of the child mainly depend on  The increase in muscular strength is mainly dye to better
his food habits & nutrition. The malnutrition has adverse circulation and oxygen supply. The brain muscles develop
effect on the structural and functional development of the by its own activity-play and other activities provide for
child.
these growth and development of various muscles.
 Races
 The racial factor has a great influence on height, weight,
colour, features and body constitution. A child of white race
will be white & tall even hair and eye colour, facial
structure are governed by the same race.

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Developmental milestones
Cont…
At 4 – 6 Weeks
 The infant is attentive to a familiar face, which is usually
Milestones (0 – 5 Years)
the mother as she is the source of food.
These are the various skills the child learns in the  The infant can lift his head from time to time when he is
process of growth and development. supported on his mother`s shoulder.
 He can also turn his head a little from side to side while
lying on a flat surface.
 He will stare at a window or a light.

Cont… Cont…
At 8 Weeks At 10 – 18 Weeks
 He can lift his chest a short distance above a flat surface  The infant can hold his head up steadily while being
when laid on his abdomen. supported on his mother`s shoulder, and turns his head
 He kicks his feet or pushes his legs when lying on his freely while looking at people and when lying on his back.
mother`s laps or in the bath basin. He smiles in response to a smiling face and shows pleasure
 Socio-personal development is marked by the attention by making sound.
he pays to a speaking voice.
 His eyes have focused and will follow a moving object.
He may smile to a familiar voice.

At 24 Weeks Cont…
 The infant has full head control and can sit with slight
At 9 – 10 Months
support.
 He can sit alone without support and may try to crawl
 He can roll from side to side in his cot. He will stretch out
when laid on his abdomen.
and grasp brightly colored objects.
 He will now be able to recognize the difference between
 He may begin to cut his first tooth which is generally one
strangers and familiar faces, family and friends.
of the lower incisors.
 He may attempt to pull himself onto his feet by holding
 He will start to learn about his surrounding by grasping
furniture.
objects with both hands especially bright beads and putting
 He begins to develop one or two skills like saying
them into his mouth. He will have doubled his birth
weight at this age. goodbye, clapping hands etc.

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At 10 – 12 Months At 15 Months
 He can stand without support and walks with some help.  The young child can walk alone and can run around but still
 He may start to hold a mug without dropping it. rather unsteadily.
 His weight will have tripled.  He can hold a mug and drink from it.

 He will obey simple orders although his vocabulary is  He can hold a spoon with increasing skill.
limited to one or two words.  His vocabulary may consist of four or more words, and he
 He will connect certain sounds with a particular object or makes serious attempts to talk but the words may be used in
situation especially the words for food in his mother the wrong sequence without making any sense.
tongue.  He should be able to eat all types of soft foods which are
 He is beginning to acknowledge authority by listening to commonly eaten in his family
his mother forbidding him certain actions

At 18 Months
 The young child can climb into a chair or up steps. At 24 Months (2 Years)
 He can use a spoon for feeding himself with good muscular coordination.  His sense of balance has well developed so he has fewer
 He usually has 10 – 12 teeth.
falls while walking around.
 He has a vocabulary of between 5 – 12 words or more and uses them as though
he were forming sentences.  He feeds himself with a spoon.
 He can turn the pages of a large book and scribble with a pencil.  He may be expected to have dry nights (but individuals
 Control of his bowels should have been established if toilet training has been differ in response to habit training).
regular.
 He will be able to tell his mother that he wants use his pottie.  He has 16 teeth, uses two or so words in combination and
 He will still sleep for 14 – 16 hours in the 24 hours. can make simple sentences.
 He will point to his nose, hair or eye when these parts are named by his parents.  He can amuse himself alone and likes playing with water
 He eats everything that his family eats apart from highly spiced or food or mud etc.
containing small bones.
 Play begins to be imitation of adult activities

Cont… Cont…
 He wants to help his mother sweep or mop the floor; help with At 30 Months (2 ½ Years) – 20 Teeth
cooking and wants to pull up plants in the shamba.  The young child goes up and down stairs alone and can
 He can now pull off his shirt or dress but finds difficulty in
unfastening buttons, tapes or straps on sandals. help his mother in the house or shamba by carrying out
 He should be now four times his birth weight and his height simple jobs.
will be about 3 feet.  He is developing a strong sense of property, about the
 He should have about 16 teeth at this age. ownership of toys and sweets.
 He is very curious about his surroundings and will pull down
knives or pots from a table, so this is a very dangerous age for  He likes going with his mother to the market and wants to
accidents in the home. carry small objects.

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Cont… Cont…
At 3 Years At 4 Years
 He can dress and un-dress himself and eats his meals  He can wash his hands and face and also clean his teeth,
without help. dress himself and fasten his sandals with help.
 He will say his name when asked, goes by himself to the  He can co-ordinate play and work activities, perform
lavatory in the day time and should be dry at night. simple jobs and go on short journeys by himself.
 He will play with small groups of children of his own age.  He is beginning to realize that he is a separate person from
 He asks questions like “Where do babies come from?” and his family.
has a vocabulary of about 150 words. He is ready for
nursery school and can learn another language with ease.

Cont… Cont…
At 5 Years  From 6 Years to 12 years
 He is beginning to realize the danger of motor cars, strange  At 6 Years
animals and fire.  He is quite prepared for entry into the large world of school
 His imagination is very strong and he will tell fantastic and if his home background has been satisfactory and
stories as his idea of truth and falsehood is very confused. secure, he will enter it with confidence.
 The formal learning of school will teach him concentration,
how to adapt to the larger world outside the home, the
ability to make friends and how to be responsible for his
own actions.

The Adolescent 12 – 18 Years

Cont…  Physical Changes
 6 – 12 Years – The School Child Boys
 This is sometimes called the Latency period as there are no  The adolescent growth spurt occurs between the 13th and
major emotional disturbances once the child has settled at 16th year and this is the period of male ascendancy. There
is a marked increase in the width of the chest and
school provided there is no home break -up due to death or
shoulders.
separation, and he feels secure.
 Muscle size increases but fat is lost at adolescence. This
 The boy will begin to peer identify with older boys and accounts for the difference in body shape between males
imitate their behavior. The same principle applies to girls. and females . Hair grows over the pubic, axillary areas, the
 Second dentition takes place from 6 – 8 years of age. chest and a beard begins to sprout on the chin, the vocal
cords lengthen and the voice becomes deep.

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 Girls
Cont…  The adolescent growth spurt occurs between 10 1/2 and 13
 The sexual organs mature and spermatozoa, erection and years which is followed by menarche (1st menstruation).
ejaculation of spermatozoa occur during sleep at night.  The physical changes include – growth of hair in the axilla and
over the pubic area, subcutaneous fat develops over the limbs,
 If the testicles have not descended into the scrotum by the
chest and pelvic region.
time the boy is 12 years, an operation is necessary to bring  Breasts begin to develop and there is a widening of the hips to
them down from the abdominal cavity. produce the typical female figure.
 Testosterone acts on the body to make boy a man.  Skin changes and pimples appear.
 If the testes remain in the abdominal cavity, they will not  Due to glandular changes, oestrogen and progesterone act on
develop to produce fertile sperms and therefore the boy the reproductive system causing the monthly cycle of ovulation
cannot produce children. and menstruation.

18 – 25 Years – Young Adulthood 25 – 40 Years – Maturity

 This is the stage when men and women have taken on the
 Physical and Psychological Changes responsibilities of adult life and accept the responsibility for their own
 The period of adolescence has passed and physical growth actions.
 Both men and women at this stage are at the height of their physical
of long bones ceases. The young adult is very concerned powers and usually undertaking their careers whether in business,
about his physical appearance. Sexual interest will begin to professions or as employees. Women are going through the physical
be focused on a definite member of the opposite sex and a changes of pregnancy, childbirth and lactating period.
 This may result in problems both physical and mental. The adult man is
choice of a life partner will be made. Both young men and expected to provide for his own family and to contribute to the general
women at this stage will be working hard at schools, good of the society in which he lives. Both men and women are
learning to adapt to a marriage partner, and the new responsibilities
colleges or in various forms of training getting ready for which marriage has brought, especially the care of a family. A man
independent adult life that lies ahead. feels proud and satisfied when his wife gives him a child. But
sometimes he feels neglected because his wife is preoccupied by the
children.

40 – 55 Years – Middle Age Old Age – 55 Years Onwards

 Physical and Psychological Changes  Physical Changes
 There is general slowing up of physical activity at this stage of life.  Slowing down of physical functions, stiffening of joints, loss of
 In women there are changes associated with the menopause. The men balance and fragile bones.
may be depressed by the reduction of their physical strength and fear of  The heart is weaker with slower circulation. The person is easily
competition of younger men. tired, feels feeble and gets breathless. This results in loss of
 Middle aged people seem to suffer from many physical aches and pains, power to perform heavy work or carry loads.
which may not be very serious, but may be feared as the beginning of a  There is failing eyesight, progressing to partial or total blindness.
fatal illness.  Loss of hearing, which results in difficulties of communication,
 The physical health should be watched carefully, help and advice given feelings of isolation and suspicious of other people. There may
for minor complaints, as they can cause great distress and worry. also be loss of the sense of smell.
 There is often a feeling of discontent at this stage of life especially if the  Bad teeth and poor digestion. This may lead to malnutrition. Old
marriage relationship has not been happy. In polygamous societies, this people have poor appetite, therefore need small highly
causes jealousy and strong increase of resentment among the older nourishing meals at frequent intervals.
wives.

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Stages of death by Kubler Ross

Cont…
 Psychological and Emotional Changes
1969
1. Denial and isolation: it is very difficult for any individual to
 Old people dislike change and they find it difficult to adjust face the fact that death is to be faced soon. The most
to new ideas and situations. They dislike changing their common reaction is to isolate oneself until defences are
surrounding and desire to die in the areas they were born. achieved.
 Old people need to feel wanted, loved and respected. They  Denial permits hope to exist but most patients are ready to
degenerate in their mental powers, become bad tempered accept the fact that they are dying but families continue to
and easily irritated. They are unreliable due to loss of express denial.
memory and sometimes become hallucinated (vision of  Denial delay, communication of concerns with the patient
people who may have died long ago suddenly appear and stopping denial and isolation by thinking about unfinished
talk to them) .This generally worries their families. business e.g. personal affairs, finances, arrangement for
 spouse, children and others. 218

3. Bargaining: third phase of dying when the person

attempts to negotiate and trade. It usually involves a
 2. Anger: the person experiences anger with the person deal with God; the physician or the nurse. E.g. If I can
asking the question; why me? The patient is difficult to live long enough to attend my son’s wedding I will be
nurse as nothing seems to please him or her. The person ready to die. If possible patients should be granted their
wants to express their outrage and helplessness. After request.
expressing their anger they move on. 4. Depression: the patient is now aware that death is
inevitable. Defense mechanism are no longer effective.
Sadness and anguish are felt and expressed.
 The patient may organize to gain support from loved
one’s and nurses.
219  The resolution leads to final stage. 220

5. Acceptance: it’s a time of relative peace. The patient wants

to review the past and think about the unknown future.
NURSING INTERVENTION
Patient may not talk a lot about but he/she wants other To give maximum help to the dying by examining the
people nearby. With pain relieve the person accepts death nurse’s own feeling about death.
and wants to be comforted by having significant others Patient is an individual and should be treated with respect
nearby. and dignity regardless of background or condition.
Social values may affect reaction to the dying person e.g.
age, attractiveness, socio-economic status, former
accomplishment. These may affect whether the person is
cared for or abandoned while dying.

221 222

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Bill of rights for a dying person

Nurses usually become the most important link with life
for the dying person. I have a right to be treated as a living human being until I
The nurse provides physical comfort and emotional die
support. It is an emotional stress to the nurse assigned to I have a right to maintain a sense of hopefulness, however
people who are dying and these need to share their changing its focus may be.
feelings and reactions with others to obtain support. I have the right to be cared for by those who can maintain
a sense of hopefulness, however changing this may be.
I have a right to express my feelings and emotions and
my approaching death in my own way.
I have a right to participate in decision concerning my
care.
223 224

I have a right to expect continuing medical and nursing I have the right to retain my individuality and not to be
attention even though “cure” goals must be changed to judged by my decision, which may be contrary to the
comfort goals. believes of others.
I have a right not to die alone. I have the right to discuss and enlarge my religious and
spiritual experience, regardless of what they mean to
I have a right to be free from pain.
others.
I have a right to have my questions answered honestly.
I have the right to expect that the sanctity of the human
I have a right not to be deceived body will be respected after death.
I have a right to help from and for my family in accepting I have the right to be cared for by caring, sensitive and
my death. knowledgeable people who will attempt to understand
I have the right to die in peace and with dignity my needs and will be able to gain some satisfaction in
helping me face my death.
225 226

Take away assignment

Any Question???
 Discuss the application of theories of personality
development in growth and development.
 Discuss the uses of classical conditioning in daily
life.

Thank You, Be Wise

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