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Chapter 8 OutlineLife StagesIntroductionGrowth and developmentStarts at birth and ends at deathGrowth is the measurable physical changes that occur throughout an individual’s lifeDevelopment is the changes in intellectual, mental, emotional, social, and functional skills that occur over timeHealth care workers must be aware of the various stages and of patients’ individual needs in order to provide quality health care.Life StagesClassificationsInfancy: birth to 1 yearEarly childhood: 1 to 6 yearsLate childhood: 6 to 12 yearsAdolescence: 12 to 18 yearsEarly adulthood: 19 to 40 yearsMiddle adulthood: 40 to 65 yearsLate adulthood: 65 years or olderFour main types of growth and development occur at each stagePhysical: refers to body growth and includes height and weight changes, muscle and nerve development, and changes in body organsMental or cognitive: refers to intellectual development and includes learning how to solve problems, make judgments, and deal with situationsEmotional: refers to feelings and includes dealing with love, hate, joy, fear, excitement, and other similar sensationsSocial: refers to interactions and relationships with othersEach stage has its own characteristics and includes specific developmental tasks an individual must master (tasks progress from simple to more complex) HOWEVER, rate of progress varies with individualsIf an individual is not able to resolve a conflict or need at the appropriate stage, the individual will struggle with the same conflict later in lifeEach life stage also creates certain needs in individuals.InfancyPhysical developmentRapid changesIncreased weight from 6-8 poundsMuscular and nervous systems are very immature at birthCertain reflex actions present at birth allow infant to respond to the environmentMoro, or startle reflex to loud noise or sudden movementRooting reflex in which a slight touch on the cheek causes the mouth to open and head to turnSucking reflex caused by a slight touch to the lipsGrasp reflex in which the infant grasps an object placed in his or her handMuscle coordination develops in stagesLift head, roll from side to back, turn their body completely around, sit unsupported, crawl, standing position, walkingInfants are born without teeth, but usually have 10 to 12 teeth by end of first yearVisionPoor at birth, limited to black and white, eye movements are not coordinatedBy 1 year, close vision is good, color, and can readily focus on small objectsSensory abilities (smell, taste, sensitivity to hot and cold, and hearing) are good at birth but become more refined and exactMental developmentRapid during first yearRespond to discomforts such as pain, cold, or hunger by cryingAs needs are met, they gradually become more aware of surroundings and begin to recognize individuals associated with their careLearning activities grow with response to stimuliSpeech: by 12 months they understand many words and use many single words in their vocabularyEmotional developmentNewborn – excitement4-6 months – distress, delight, anger, disgust and fear12 months – elation and affection for adults social developmentprogresses from the total self-centered concept of the newborn to a gradual recognition of others in the environmentEarly childhood: ages 1 to 6Physical developmentSlows downSkeletal and muscle development helps child assume a more adult appearanceTeeth have erupted and digestive system is mature enough to handle most adult foodsLearn bladder and bowel controlMental developmentAdvances rapidly 1,500 to 2,500 known words by 6 yearsby 6 years, memory has developed to where a child can make decisions based on past and present experiencesEmotional developmentBegin to develop self-awareness and to recognize the effect they have on others or other thingsBegin to gain more control over their emotions, achieve more independenceSocial developmentExpands from self-centered to very socialLearn to trust others and make more of an effort to please othersNeedsFood, rest, shelter, protection, love, security, routine, order, and consistency in daily livesMust learn how to be responsible and to conform to rulesLate Childhood or preadolescence: ages 6 to 12Physical developmentSlow by steadyMuscle coordination is well developedPermanent teeth start to eruptMental developmentIncreases rapidly because of schoolLearns to use information to solve problemsBegin to understand more abstract concepts such as loyalty, honesty, values, and moralsEmotional developmentContinues to achieve greater independence and more distinct personalitySexual maturation and changes in body functions can lead to periods of depression followed by joySocial changesTend to like activities they can do by themselves, then tend to be more group-orientedMore ready to accept opinions from othersBegin to develop an increasing awareness of the opposite sexNeedsBasic needsAlso reassurance, parental approval, and peer acceptanceAdolescence: ages 12 to 18Physical developmentDramatic in early period “growth spurt”Muscle coordination does not occur as quickly, which can lead to awkwardness and clumsinessPuberty: development of sexual organs and secondary sexual characteristics, secretion of sex hormonesMental developmentIncrease in knowledgeLearn to make decisions and to accept responsibility for their actionsCauses conflict at times because they are treated as both children and adultsEmotional developmentStormy and in conflictOften uncertain and feel inadequate and insecure as they try to establish their identity and independenceWorry about their appearance and relationships with othersRespond more to peer group influencesSocial developmentMove away from family to association with peer groupsSeek security in groups of people their own age with similar problems and conflictsToward end of adolescence, develop a more mature attitude and patterns of behavior that they associate with adult behavior or statusNeedsReassurance, support, and understanding along with basic needsConflict and feelings of inadequacy and insecurity lead to development of problems (eating disorders, drug and alcohol abuse, suicide)Eating disorders often develop from an excessive concern with appearance (more frequent in females)Chemical abuse due to:Trying to relieve anxiety or stressPeer pressureEscape from emotional or psychological problemsExperimentation with feelings the chemicals produceSeeking “instant gratification”Hereditary traits or cultural influencesCan lead to physical and mental disorders and diseasesSuicide is a permanent solution to a temporary problem. Impulsive nature increases the possibility of suicide.Early adulthood: ages 19 to 40Physical developmentMost productive life stagePhysical development is basically completePrime childbearing time, sexual development as at its peakMental developmentContinues throughout this stageMake many decisions and form many judgmentsEmotional developmentInvolves preserving the stability established during previous stagesSubjected to many emotional stresses related to careers, marriage, family, and other situationsLearn to accept criticism and to profit from mistakesSocial developmentMove away from peer groupsAssociate with others who have similar ambitions and interests regardless of age Middle adulthood or middle age: 40 to 65Physical changes occur: gray hair, wrinkles, muscle tone decreases, hearing and vision loss, weight gain, slowing of hormone productionMental developmentHave acquired an understanding of lifeLearned to cope with many different stressesMore confident decision makersExcellent at analyzing situationsSocial developmentfamily relationships often see a decline (children move)Late adulthood: 65 and upPhysical developmentDecline of all body systemsMental developmentPeople who remain mentally active and are willing to learn new things show fewer signs of decreased mental abilityShort-term memory is usually first to declineEmotional developmentSome cope well with presentation of aging and remain happy and able to enjoy life; others become lonely, frustrated, withdrawn, and depressed.Emotional adjustment is necessary at this stage. (retirement, death of spouse and friends, physical disabilities, financial problems, loss of independence, knowledge that life must end)Social developmentMore limited circle of friends (but development of new social contacts is important)DEATH AND DYING“The final stage of growth”; can not be evadedTerminal illness: disease that cannot be cured that will result in deathPeople react in different ways – some with fear and anxiety, some view death as a final peaceFive stages of grieving (stages may not occur in order, some may have several stages at the same time)Denial “NO, not me!”Usually occurs when a person is first told of terminal illness, cannot accept reality of deathMay refuse to discuss illness and avoid any reference to itRole of health care workerImportant for patients to discuss these feelings, allows them to move on to next stageShould listen to patientProvide support with out confirming or denyingAnger “Why me?”Occurs when patient is no longer able to deny deathMay become hostile and bitterRole of health care workerUnderstand that this anger is not a personal attackProvide understanding and supportListenMake every attempt to respond to patient’s demands quickly and kindlyBargainingOccurs when patients accept death but want more time to liveFrequently turn to religion and spiritual beliefsPatient fights hard to achieve goals set (graduate/married, arrange care for family, etc)Role of health care workerBe supportive and a good listenerHelp patients meet their goals whenever possibleDepressionOccurs when patient realizes death will come soonNo longer want to be with their familiesMay express regrets or withdrawGreat sadness and over-whelming despairRole of health care workerLet patients know that it is “okay” to be depressedProvide quiet understanding and supportProvide simple touchAllow patients to cry or express griefacceptanceUnderstand and accept the fact that they are going to dieTry to help those around them deal with deathGradually separate themselves from the world and other peopleAt end, they are at peace and can die with dignityRole of health care workerProvide emotional support Care of dying patientsVery difficult, but very rewardingHealth care workers must understand their own personal feelings about death and come to terms with those feelingsHospice CareOffers palliative care (support and comfort) for patient and their familyUsually not started until a physician declares the patient has six months or less to livePhilosophy is to allow the patient to die with dignity and comfortProvides comforts that include: hospital equipment, psychological, spiritual, social, and financial counselingPain is controlled so patient can remain active as long as possibleSpecially trained Volunteers may assist with health care providersAfter death, hospice personnel often maintain contact with family during the initial period of mourning.Dying Person’s Bill of RightsRight to be treated as a living human being until I dieRight to maintain a sense of hopefulness, however changing its focus may beRight to express my feelings and emotions about my approaching death in my own wayRight to participate in decisions concerning my careRight to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goalsRight not to die aloneRight to be free from painRight to have my questions answered honestlyRight to have help from and for my family in accepting my deathRight to die in peace and with dignityRight to maintain my individuality and not be judged for my decisions, which may be contrary to the belief of othersRight to expect that the sanctity of the human body will be respected after deathRight to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needsRight to discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to othersRight to dieHealth care workers are ethically concerned with promoting life, so allowing patients to die can cause conflict.Laws allowing “right to die”State lawsAllow adults with a terminal illness to instruct their doctors, in writing, to withhold treatments that might prolong life (advance directives)Specific actions to end life cannot be taken. However, the use of respirators, pacemakers, and other medical devices can be withheld.Human NeedsIntroductionNeeds are defined as a lack of something that is required or desiredNeeds motivate the individual to behave or act so that the needs will be met if at all possiblePriority of needsCertain needs have priority over other needs (food or social approval). Will do anything to receive needMaslow’s hierarchy of needsPhysiological needsPhysical or biological needsRequired to sustain life, if not met death will occurFood, water, oxygen, elimination of waste materials, sleep, and protection from extreme temperaturesSensory and motor needsHearing, seeing, feeling, smelling, tasting, and mental stimulation (may lose contact with environment if not met)Health care workers must be aware of how an illness interferes with meeting physiological needs (anxiety, medications effects, etc). if needs can not be met, workers need to provide understanding and support.SafetyNeed to be free from anxiety and fear and need to feel secure in the environmentNeed order and routineIllness is a major threat to an individual’s security and well beingWorkers must explain the reason for the tests or treatments and the expected outcomes to alleviate anxietyPatients must also adapt to strange and new environment (hospital)Love and affectionMotivated by need to belong, to relate to others, and to win approval of othersEsteemFeeling important and worthwhile. Gains self respect when others show respect, approval, and appreciation.Illness can have an effect. becoming dependent on othersworry about lack of income, job loss, family, possibility of permanent disability or deathHC workers must try to encourage as much independence as possibleSelf-actualization (self-realization)Final needAll other needs must be met, before this can occurMeans that people have obtained their full potential, or that they are what they want to beAt this level, people are confident and willing to express their beliefs and stick to themMeeting needsIndividuals are stimulated to act when needs are feltIf the need is not met, tension or frustration occursNeeds can have different levels of intensity (food)Methods of satisfying human needsSatisfied by direct or indirect methodsDirect methodsWork at meeting need and obtaining satisfactionSet realistic goals that will allow them to find successEvaluate the situation to determine why they are failingCooperate with othersIndirect methodsWork at reducing the need if unmet (intensity decreases)Defense mechanisms are the main indirect methods used. Unconscious acts that help a person deal with an unpleasant situation or socially unacceptable behaviorEveryone uses defense mechanisms to some degree. Can be unhealthy if used all the time and substituted for more effective ways of dealing with situationsProvide method for maintaining self esteem and relieving discomfortRationalizationUsing a reasonable excuse or an acceptable explanation for behavior to avoid the real reason or true motivation ProjectionPlacing the blame for one’s own actions or inadequacies on someone else or on circumstances rather than accepting the responsibility for actionsDisplacementTransferring feelings about one person to someone else (prejudice) CompensationSubstitution of one goal for another goal to achieve success (healthy if substitution goal meets needs)DaydreamingProvides a means of escape when a person is not satisfied with reality (good only if allows a person to establish goals for future and leads to accomplishing goals. Poor if it is an escape from reality. )RepressionInvolves the transfer of unacceptable or painful ideas, feelings, and thoughts into the unconscious mind (individuals not aware happening)Repressed feelings to not vanish (frightened of heights)SuppressionIndividual is aware of the unacceptable feelings or thoughts and refuses to deal with them (substitute work/hobby to avoid situations) Causes excessive stress, must eventually deal with situation.DenialInvolves disbelief of an event or idea that is too frightening or shocking for a person to acceptWithdrawalCease to communicate or remove themselves physically from situation (working with person you do not like) ................
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