1Erikson's Stages of Development
Stage 1: Trust vs. Mistrust (Infancy from birth to 18 months)
Stage 2: Autonomy vs. Shame and Doubt (Toddler years from 18 months to three years)
Stage 3: Initiative vs. Guilt (Preschool years from three to five)
Stage 4: Industry vs. Inferiority (Middle school years from six to 11)
Stage 5: Identity vs. Confusion (Teen years from 12 to 18)
Stage 6: Intimacy vs. Isolation (Young adult years from 18 to 40)
Stage 7: Generativity vs. Stagnation (Middle age from 40 to 65)
Stage 8: Integrity vs. Despair (Older adulthood from 65 to death)
2FACTORS THAT AFFECT RESPONSES TO ILLNESS AND HOSPITALIZATION
1. developmental stage of the child
2. nature of the illness or injury
3. level of anxiety of both child and parents
4. type of relationship that exists between parents and the child
5. past experiences with hospitalization, medical treatment and surgical procedures
6. support systems
7. socio-cultural factors-gender; race and culture; age
3MAJOR SOURCES OF FEARS/STRESSORS FOR THE HOSPITALIZED CHILD
1. Separation anxiety
2. Loss of control
3. Fear of bodily injury/pain
4Stages of Separation Anxiety
1. Protest
2. Despair
3. Denial/Detachment
5What Stage of Separation Anxiety is when:
🠢 few hours-days; reacts aggressively to the separation from the parent
🠢 loud crying, wants parents, overt behavior, rejects attention of nurses/anyone
else
1. Protest
6What Stage of Separation Anxiety is when:
🠢 May last for a variable length of time
🠢 withdrawn, uncommunicative, uninterested in environment, inactive
🠢 regressive behaviors
🠢 physical condition may deteriorate from refusal to eat, drink or move
🠢 when parents reappear, child returns to protest behaviors
2. Despair
7What Stage of Separation Anxiety is when:
🠢 Occurs after prolonged separation from parents
🠢 Rare; occurs in long-term illness
🠢 Superficially seems adjusted to loss-ignores parents; with increased interest in
the environment; plays with others and seems to form new relationships
3. Denial/Detachment
8influences amount of stress and increases the perception of threat and affects children’s coping skills
Loss of control
9imposed from physical restriction/limitation of movement, altered routines or rituals, and dependency (loss of the ability to make decision)
Loss of control
10What stage of development is when:
Separation anxiety begins after 6 months
INFANTS (0-12 months)
11What stage of development is when:
Inconsistent care and deviations from the daily routine may lead to mistrust and a decreased sense of control
INFANTS (0-12 months)
12What stage of development is when:
Older infants react intensely with physical resistance and uncooperativeness; distraction does little to lessen their immediate reaction to pain and anticipatory preparation can increase their fear and resistance.
INFANTS (0-12 months)
13What stage of development is when:
▪ Reacts to separation from parents with more goal-directed behaviors
▪ Separation anxiety is at its peak
TODDLER (1-3 years)
14What stage of development is when:
▪ Reacts with negativism, forceful resistance or non-compliance, regression
▪ Prolonged loss of autonomy could lead to passive withdrawal and regression in all areas of development.
TODDLER (1-3 years)
15What stage of development is when:
▪ Poorly developed concept of body image
▪ React to painless procedures as intensely as they do to painful ones
TODDLER (1-3 years)
16What stage of development is when:
▪ Unlike adults who decrease their activity when in pain, they typically become restless and overtly active.
▪ By the end of this period, usually are able to communicate about their pain.
TODDLER (1-3 years)
17What stage of development is when:
▪ Generally less obvious and less serious than in the toddler
▪ As stress increases, their ability to separate from the parents decreases.
▪ May express anger by displacementor refuses to cooperate during usual self-care activities
PRESCHOOLER (3-6 years)
18What stage of development is when:
▪ Specific cognitive abilities (EGOCENTRIC AND MAGICAL THINKING) which make them feel omnipotent and all-powerful also makes them feel out of control.
▪ A typical fantasy to explain illness or hospitalization is that it represents punishment for real or imagined misdeeds
PRESCHOOLER (3-6 years)
19What stage of development is when:
▪ Concept of illness begins during the preschool period and is influenced by the cognitive abilities of the preoperational stage. Their thinking is based on externally perceived events and causality is based on the proximity of two events.
PRESCHOOLER (3-6 years)
20What stage of development is when:
▪ Concept of body integrity still poorly developed.
▪ Psychosexual conflicts make them more vulnerable to threats of bodily injury.
▪ Concerns of mutilation are greatest at this age. Loss of any body part is threatening.
PRESCHOOLER (3-6 years)
21What stage of development is when:
▪ Similar reactions to pain with toddlers but respond more favorably than younger children to preparatory procedures
▪ Can locate pain and can use appropriate pain scale
PRESCHOOLER (3-6 years)
22What stage of development is when:
▪ Better able to cope with separation in general but as stressors are added the separation becomes more difficult
SCHOOL AGE (6-12 years old)
23What stage of development is when:
▪ Young school age children may have increased need for security and guidance; Middle-late school age children are concerned more on separation from their usual activities and peers than to absence of their parents.
SCHOOL AGE (6-12 years old)
24What stage of development is when:
▪ May react to separation by loneliness, boredom and depression
SCHOOL AGE (6-12 years old)
25What stage of development is when:
▪ Strives for independence and productivity making them vulnerable to events that lessentheir feeling of control and power. Causes of loss of control include: altered family roles; physical disability; fears of death, abandonment, or permanent injury; inability to cope with stress according to perceived cultural expectation.
SCHOOL AGE (6-12 years old)
26What stage of development is when:
▪ An increased sense of control usually results from a feeling of usefulness and productivity.
▪ Boredom is a significant problem.
SCHOOL AGE (6-12 years old)
27What stage of development is when:
▪ Emphasizing areas of control and capitalizing on quiet activities promote their adjustment to physical restriction.
SCHOOL AGE (6-12 years old)
28What stage of development is when:
▪ More concerned with disability, uncertain recovery or possible death than pain.
▪ Begin to show concern for the potential and hazardous effects of procedures.
▪ Intrusive procedures of nonsexual nature are well tolerated. Concern for PRIVACY becomes significant.
SCHOOL AGE (6-12 years old)
29What stage of development is when:
Show less fright or overt resistance to pain than younger children. If they do display signs of overt resistance they may deny such reactions later especially to their peers for fear of embarrassment.
SCHOOL AGE (6-12 years old)
30What stage of development is when:
▪ Can communicate pain in terms of location, intensity and description. Also uses words as a means of controlling their reaction to pain.
SCHOOL AGE (6-12 years old)
31What stage of development is when:
▪ Seeking information tends to be one way of coping or maintaining a sense of control despite the stress and uncertainty of the condition.
SCHOOL AGE (6-12 years old)
32What stage of development is when:
▪ Rarely initiate a conversation about their feelings or request someone to stay with them during a lonely or stressful period.
SCHOOL AGE (6-12 years old)
33What stage of development is when:
▪ Separation from parents is a welcomed event
▪ Loss of peer group contact poses a severe threat because of loss of group status, inability to exert group control or leadership or loss of group acceptance
ADOLESCENT (12-18 years old)
34What stage of development is when:
Anything that interferes for their quest for independence, self-assertion and liberation poses a threat to their sense of identity and results to a loss of control.
ADOLESCENT (12-18 years old)
35What stage of development is when:
▪ Reactions to physical limitation from illness and separation from support systems and dependency= uncooperativeness, rejection and withdrawal
ADOLESCENT (12-18 years old)
36What stage of development is when:
They are more sensitive to instances of loss of control and dependency than are younger children. They react not only to the kind of information supplied to them but also the means by which it is conveyed.
ADOLESCENT (12-18 years old)
37What stage of development is when:
▪ Concern about body image is greatest at this age.
▪ Privacy is a concern. Lack of respect for this need can cause greater stress than physical pain.
ADOLESCENT (12-18 years old)
38What stage of development is when:
▪ Typically react to pain with much self control
▪ Able to describe pain experience and use any assessment tools developed for adults.
However, they may be reluctant to disclose their pain.
ADOLESCENT (12-18 years old)
39What stage of development is when:
begin to understand illness but not its cause and effect
toddler
40What stage of development is when:
more realistic underestanding of reasons of illness
school age
41What stage of development is when:
increased awareness of psychological related illnesses
adolescent
42also known as anaclitic depression
separation anxiety
43what occurs if social withdrawal, weight loss, sleplessness, and retarded psychomotor are left unattended after 3 months
physical rigidity
44stage of separation ancxiety in whic manifestation includes incessant, crying, and temper tantrums
protest
45stage of separation ancxiety in whic manifestation includes withdrawal, isolation, and depression
despair
46if autonomy is threatened, it is imposed by:
a. physical restriction
b. altered routines or rituals
c. dependency
47what is fear of mutilation called?
castration
48INFANTS (0-12 months)
common fear:
play:
common problem/s:
common fear
: stranger anxiety
play
: solitary/observation
common problem/s
: aspiration
: common cough and colds
: falls
49what stage of development is when OBJECT PERMANENCE developed?
INFANTS (0-12 months)
50What stage of development is when:
attempts to control environment through emotional expressions by smiling and crying
INFANTS (0-12 months)
51at what month of infancy does infant recognizes mother?
4 months
52at what month of infancy does infant develop individuation?
4-8 months
53at what month of infancy does infant show preference to mother?
6 months
54TODDLER (1-3 years)
common fear:
most significant others:
play:
common problem/s:
common fear: separation anxiety
most significant others: parents
play: parallel
common problem/s: falls | acidents
: burns
: poisoning
: drowning
: choking
55What stage of development is when:
characteristics:
ritual and routines
explorer
negativistic
no concept of sharing
temper tantrums
securing blanket
TODDLER (1-3 years)
56What stage of development is when:
reacts with: temper tantrums
: refusal with usual routines
: regression
TODDLER (1-3 years)
57What stage of development is when:
- becomes restless and overtly active
- reacts with intense emotional upset and physical resistance
- fears and reacts to intrusive procedures
TODDLER (1-3 years)
58What stage of development is when:
characteristics:
- egocentericity
- magical thinking
- animism
- peak development of super ego
- oesipus/electra complex
- inquisitive
- normal masturbation
- talks constantly
PRESCHOOLER (3-6 years)
59What stage of development is when:
separation anxiety is viewed as a form of punishment
PRESCHOOLER (3-6 years)
60PRESCHOOLER (3-6 years)
most significant other:
common fear:
play:
common problem/s:
most significant other: family
common fear: fear of the dark
play: cooperative
common problem/s: threatened safety
61What stage of development is when:
responds by:
- lack/loss of appetite
- sleep disturbances
- quiet crying
- enuresis
PRESCHOOLER (3-6 years)
62What stage of development is when:
- express anger by displacement
- reacts with regression
- becomes more cooperative
PRESCHOOLER (3-6 years)
63perceives an external, unrelated, concrete phenomenon as a cause of illness
phenomenism
64perceives cause of ilness as proximity between 2 events that occurs by "magic"
contagion
65PRESCHOOLER (3-6 years)
most significant others:
common fear:
play:
common problem/s:
most significant others: teacher
common fear: death anxiety
play: competitive
common problem/s: physical injuries
66What stage of development is when:
- competitive
- well developed ID, ego, and superego
normal homosexuality
- has more realistic understanding of various events
PRESCHOOLER (3-6 years)
67What stage of development is when:
- shows agression, irritability, and inability to relate to siblings or peers
PRESCHOOLER (3-6 years)
68What stage of development is when:
- altered family roles
- physical disabilities
- fear of death, abandonment, or permanent injury
- inability to cope with stress accordingly
SCHOOL AGE (6-12 years old)
69ADOLESCENT (12-18 years old)
most significant others:
common fear:
major concern:
play:
most significant others: peers
common fear: separation (from peers)
major concern: privacy/modesty
play: competitive
70What stage of development is when:
characteristics: preocupies with appearance
: risk takers
: competition are very important
: struggles for independence, self assertion, ...
ADOLESCENT (12-18 years old)